Tussigon

Generic: homatropine methylbromide

1.5 MG — Tablet

Also known as: homatropine methylbromide
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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 5 hours, 24 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect myDiabetesCare Silver
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Bronze CMS Standard
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Bronze RD CMS Standard
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Gold CMS Standard
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Silver CMS Standard
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Gold RD CMS Standard
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Silver RD CMS Standard
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Silver 3000 Indiv Med Deductible
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect myDiabetesCare Bronze
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Silver 4400 Indiv Med Deductible
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Silver 3500 Indiv Med Deductible
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible
via Hydromet 		Tier 2 - Generic — — ✓ QL
Connect Gold 1500 Indiv Med Deductible
via Hydromet 		Tier 2 - Generic — — ✓ QL
Source: CMS QHP JSON  ·  Checked: 5 hours, 24 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AIAN Cost Share | with Atrium Health Tier 2 - Generic — — — None
Bronze Classic 4700 | with Atrium Health Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health Tier 2 - Generic — — — None
Silver Classic | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Diabetes | with Atrium Health Tier 2 - Generic — — — None
Silver Simple PCP Saver | with Atrium Health Tier 2 - Generic — — — None
Gold Elite Saver Plus | with Atrium Health Tier 2 - Generic — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 2 - Generic — — — None
Bronze Simple Chronic Care CKM | with Atrium Health Tier 2 - Generic — — — None
Bronze Simple Diabetes | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Chronic Care CKM | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 2 - Generic — — — None
AIAN Cost Share Tier 2 - Generic — — — None
Bronze Classic Standard
via Hydromet 		Tier 2 - Generic — — — None
Silver Classic Standard
via Hydromet 		Tier 2 - Generic — — — None
Gold Classic Standard
via Hydromet 		Tier 2 - Generic — — — None
Bronze Classic Standard | with Atrium Health
via Hydromet 		Tier 2 - Generic — — — None
Silver Classic Standard | with Atrium Health
via Hydromet 		Tier 2 - Generic — — — None
Gold Classic Standard | with Atrium Health
via Hydromet 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus
via Hydromet 		Tier 2 - Generic — — — None
Silver Classic
via Hydromet 		Tier 2 - Generic — — — None
Secure
via Hydromet 		Tier 2 - Generic — — — None
Bronze Classic 4700
via Hydromet 		Tier 2 - Generic — — — None
Silver Simple PCP Saver
via Hydromet 		Tier 2 - Generic — — — None
Gold Elite Saver Plus
via Hydromet 		Tier 2 - Generic — — — None
Silver Simple Diabetes
via Hydromet 		Tier 2 - Generic — — — None
Secure | with Atrium Health
via Hydromet 		Tier 2 - Generic — — — None
Bronze Classic 4700 | with Atrium Health
via Hydromet 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health
via Hydromet 		Tier 2 - Generic — — — None
Silver Classic | with Atrium Health
via Hydromet 		Tier 2 - Generic — — — None
Silver Simple Diabetes | with Atrium Health
via Hydromet 		Tier 2 - Generic — — — None
Silver Simple PCP Saver | with Atrium Health
via Hydromet 		Tier 2 - Generic — — — None
Gold Elite Saver Plus | with Atrium Health
via Hydromet 		Tier 2 - Generic — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Hydromet 		Tier 2 - Generic — — — None
Bronze Simple Chronic Care CKM | with Atrium Health
via Hydromet 		Tier 2 - Generic — — — None
Bronze Simple Diabetes | with Atrium Health
via Hydromet 		Tier 2 - Generic — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Hydromet 		Tier 2 - Generic — — — None
Silver Simple Chronic Care CKM | with Atrium Health
via Hydromet 		Tier 2 - Generic — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Hydromet 		Tier 2 - Generic — — — None
AIAN Cost Share
via Hydromet 		Tier 2 - Generic — — — None
AIAN Cost Share | with Atrium Health
via Hydromet 		Tier 2 - Generic — — — None
Bronze Classic Standard Tier 2 - Generic — — — None
Silver Classic Standard Tier 2 - Generic — — — None
Gold Classic Standard Tier 2 - Generic — — — None
Bronze Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Silver Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Gold Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus Tier 2 - Generic — — — None
Silver Classic Tier 2 - Generic — — — None
Secure Tier 2 - Generic — — — None
Bronze Classic 4700 Tier 2 - Generic — — — None
Silver Simple PCP Saver Tier 2 - Generic — — — None
Gold Elite Saver Plus Tier 2 - Generic — — — None
Silver Simple Diabetes Tier 2 - Generic — — — None
Secure | with Atrium Health Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 5 hours, 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Silver Standard (No Referrals)
via Hydromet 		Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via Hydromet 		Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Gold Standard (No Referrals)
via Hydromet 		Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Hydromet 		Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Bronze Standard+ Dental + Vision (No Referrals)
via Hydromet 		Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Hydromet 		Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Hydromet 		Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via Hydromet 		Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via Hydromet 		Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Bronze Standard (No Referrals)
via Hydromet 		Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via Hydromet 		Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via Hydromet 		Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Hydromet 		Tier 1 - Preferred Generic ✓ — ✓ PA | QL
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