Prior authorization for this drugįor certain drugs, The Plan limits the amount of the drug that will be covered. For example, “30 EA per 30 days” would mean your coverage of this drug is limited to 30 pills every 30 days, or 1 pill per day. If you do not getĪpproval, The Plan may not cover the drug.Īpproval, The Plan may not cover the drug. This means that you will need to getĪpproval from The Plan before you fill your prescriptions.
of levothyroxine to return the TSH back to normal is in the 100125 mcg range. The Plan requires you or your physician to get Levothyroxine (T4): the major hormone produced by the thyroid gland and. Maintenance medications are generally those used to treat chronic conditions and long-term conditions. You may be taking these drugs on a long-term basis. Generic drugs cost less than brand name drugs. A generic drug is approved by the FDAĪs having the same active ingredient as the brand name drug. for Health First Health Plans' or 1.844.522.5279
#Levothyroxine 88 mcg how to
To find out how to request a formulary exceptionġ.855.443.4735 (TTY/TDD relay: 1.800.955.8771) Monday through Friday from 8 a.m. You can try to find a coveredįormulary alternative in the same therapeutic class. This tier includes some select preventive products, prescription medications and specific over-the-counter (OTC) medications available to you at no cost-sharing ($0) when applicable conditions are met.ĭrug is not listed on the Formulary (Drug List). Limited to a 30-day supply. Details about your specific benefit for each tier are included in your Summary of Benefits. Levothyroxine (Synthroid, Levoxyl) 88mcg Tablets Generic Equivalent To Synthroid, Levoxyl, Levothroid Price: Select Quantity Below Prescription Required In Stock - Select Quantity (Tablets) - 15 Tablets 26.40 30 Tablets 35.00 (Save 33) 45 Tablets 43.00 (Save 45) 60 Tablets 48.00 (Save 54) 90 Tablets 56. Must be obtained from Health First Family Pharmacy when possible and are This tier includes Specialty Drugs (SP) that Some plans may be limited to a 30 day supply. Details about your specific benefit for each tier are included in your Summary of Benefits. This tier includes brand name drugs and some Synthroid, Tablet, 88 Mcg150 Mcg137 Mcg125 Mcg50 Mcg25 Mcg200 Mcg75 Mcg100 Mcg300. This tier includes preferred brand name drugsĪnd some higher cost generic drugs. Details about your specific benefit for each tier are included in your Summary of Benefits. This tier includes generic drugs. Details about your specific benefit for each tier are It is used to treat thyroid hormone deficiency. Levothyroxine Sodium Tablets, USP Color Additives Strength (mcg) Color. Includes preferred generic drugs. Details about your specific benefit for each tier are Levothyroxine, also known as L-thyroxine, is a manufactured form of the thyroid hormone thyroxine (T4). Levothyroxine Sodium LEVOTHYROXINE SODIUM 88 ug/1 Amneal Pharmaceuticals NY LLC. This is the lowest cost sharing tier that Thyroid Hormones - Synthetic T4 (Thyroxine)
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