Does Standard Silver 22 Health cover theophylline?
Standard Silver 22 Health
13887-13887FL0010002-0 · ACA · ACA Marketplace
theophylline
theophyllineunder Standard Silver 22 Health
Covered — just walk in
Nothing to clear first — take the prescription to an in-network pharmacy.
What you'd pay
$20per 30-day fill
From the first fill — no deductible on this drug.
This is the standard amount. If you qualified for a cost-sharing reduction when you enrolled, set your level above and this will follow it.
- Tier
- Generics
- Approval first
- Not needed
- Try another first
- No
- Amount limit
- None
Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 14, 2026 · CMS QHP machine-readable. Reference information, not medical advice and not a price.
Covered forms and strengths (12)
- theophylline 100 MG Extended Release Oral Capsule [Theo-24]
- theophylline 100 MG Extended Release Oral Tablet
- theophylline 200 MG Extended Release Oral Capsule [Theo-24]
- theophylline 200 MG Extended Release Oral Tablet
- theophylline 300 MG Extended Release Oral Capsule [Theo-24]
- theophylline 300 MG Extended Release Oral Tablet
- theophylline 400 MG Extended Release Oral Capsule [Theo-24]
- theophylline 400 MG Extended Release Oral Tablet
- theophylline 450 MG Extended Release Oral Tablet
- theophylline 5.33 MG/ML Oral Solution
- theophylline 5.33 MG/ML Oral Solution [Elixophyllin]
- theophylline 600 MG Extended Release Oral Tablet