Tussigon
Generic: homatropine methylbromide
1.5 MG — Tablet
Cholinergic Muscarinic Antagonist
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.
Oscar Health
54 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Silver Simple Diabetes with Adult Dental & Vision | with Atrium Health
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010085
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
Bronze Elite + PCP Saver Plus with Adult Dental & Vision
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
Bronze Simple Diabetes
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
Silver Core Plan
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
Silver Core Plan | with Atrium Health
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Diabetes with Adult Dental & Vision
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010108
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010109
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010110
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010111
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010112
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010113
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010114
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010115
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010116
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010117
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
Bronze Simple Diabetes with Adult Dental & Vision | 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 |
|
Silver Simple Diabetes
via Hydromet |
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 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 |
|
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 |
|
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 |
|
69803NC0010074
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010075
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
Bronze Elite + PCP Saver Plus with Adult Dental & Vision | with Atrium Health
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010076
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010077
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010078
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010079
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010080
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010081
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010082
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010083
via Hydromet |
Tier 2 - Generic | — | — | — | None |
|
69803NC0010084
via Hydromet |
Tier 2 - Generic | — | — | — | None |
UnitedHealthcare
17 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)
via Hydromet |
Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via Hydromet |
Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
|
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)
via Hydromet |
Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)
via Hydromet |
Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via Hydromet |
Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
|
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, 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 |
|
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)
via Hydromet |
Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
|
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Hydromet |
Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, 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 Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Hydromet |
Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
|
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via Hydromet |
Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
|
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)
via Hydromet |
Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
|
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)
via Hydromet |
Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
|
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Hydromet |
Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals)
via Hydromet |
Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |