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Medication Lookup

The results below have been sorted using a 2-tier plan. For the most accurate search results, check your plan details and choose another tier plan from the drop-down menu near the search bar.

LEVOTHYROXINE SODIUM
THERAPEUTIC CLASS: Thyroid Hormones
Select a strength to see details

100MCG TABS

100MCG TABS
Covered by a 3-Tier Plan as a Tier 1 Medication
Learn more about tiers.

112MCG TABS

112MCG TABS
Covered by a 3-Tier Plan as a Tier 1 Medication
Learn more about tiers.

125MCG TABS

125MCG TABS
Covered by a 3-Tier Plan as a Tier 1 Medication
Learn more about tiers.

137MCG TABS

137MCG TABS
Covered by a 3-Tier Plan as a Tier 1 Medication
Learn more about tiers.

150MCG TABS

150MCG TABS
Covered by a 3-Tier Plan as a Tier 1 Medication
Learn more about tiers.

175MCG TABS

175MCG TABS
Covered by a 3-Tier Plan as a Tier 1 Medication
Learn more about tiers.

200MCG SOLR

200MCG SOLR
Covered by a 3-Tier Plan as a Tier 1 Medication
Learn more about tiers.

200MCG TABS

200MCG TABS
Covered by a 3-Tier Plan as a Tier 1 Medication
Learn more about tiers.

25MCG TABS

25MCG TABS
Covered by a 3-Tier Plan as a Tier 1 Medication
Learn more about tiers.

300MCG TABS

300MCG TABS
Covered by a 3-Tier Plan as a Tier 1 Medication
Learn more about tiers.

50MCG TABS

50MCG TABS
Covered by a 3-Tier Plan as a Tier 1 Medication
Learn more about tiers.

75MCG TABS

75MCG TABS
Covered by a 3-Tier Plan as a Tier 1 Medication
Learn more about tiers.

88MCG TABS

88MCG TABS
Covered by a 3-Tier Plan as a Tier 1 Medication
Learn more about tiers.

500MCG/5ML VIAL

500MCG/5ML VIAL
Covered by a 3-Tier Plan as a Tier 3 Medication
Learn more about tiers.

100MCG/5ML VIAL

100MCG/5ML VIAL
Covered by a 3-Tier Plan as a Tier 3 Medication
Learn more about tiers.

200MCG/5ML VIAL

200MCG/5ML VIAL
Covered by a 3-Tier Plan as a Tier 3 Medication
Learn more about tiers.

 Prior Authorization Forms

Massachusetts Standard Form for Hepatitis-C Medication Prior Authorization Requests

Massachusetts Standard Form for Medication Prior Authorization Requests

Massachusetts Standard Form for Synagis® Medication Prior Authorization Requests

 Important Information

Affordable Care Act (ACA) Medication List

Maintenance Medication List

Medical Benefit Prior Authorization Medication List

Over-the-Counter Exclusion Medication List

Quality Care Dosing Guidelines

Step Therapy Medication List

Learn About Your Pharmacy Program

Learn About Tiers

Learn About Your Pharmacy Program

$0 Copay Medication List

Affordable Care Act (ACA) Medication List

Cost-Share Assistance Program Medication List

Health Savings Account (HSA) Preventive Medication List

Lower-Cost, Brand-Name Insulins Medication List

Maintenance Medication List

Medical Benefit Prior Authorization Medication List

No-Cost Generic Medications List

Over-the-Counter Exclusion Medication List

Quality Care Dosing Guidelines

Step Therapy Medication List

 Specialty Pharmacy

Specialty Pharmacy Medication List

5-Tier Specialty Pharmacy Medication List

6-Tier Specialty Pharmacy Medication List

Specialty Network Pharmacy Contact Information

Specialty Network Pharmacy Contact Information

 Alternatives to Opioids

Covered Pain Management Medication List

Alternatives to Opioid-Based Medications

 For Federal Employee Program Members

Visit fepblue.org to search the formularies

 Eligible Medicare Members

Search a Medicare Formulary

Covered Alternative Medications