Does 58081ga0010077 cover levothyroxine?
58081ga0010077
58081-58081GA0010077-0 · ACA · ACA Marketplace
levothyroxine
levothyroxineunder 58081ga0010077
Covered — just walk in
Nothing to clear first — take the prescription to an in-network pharmacy.
What you'd pay
This plan doesn't publish a price for this tier. Your pharmacy can quote it before you fill.
- Tier
- Generic
- 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 (44)
- levothyroxine sodium 0.025 MG Oral Tablet
- levothyroxine sodium 0.025 MG Oral Tablet [Levoxyl]
- levothyroxine sodium 0.025 MG Oral Tablet [Synthroid]
- levothyroxine sodium 0.025 MG Oral Tablet [Unithroid]
- levothyroxine sodium 0.05 MG Oral Tablet
- levothyroxine sodium 0.05 MG Oral Tablet [Levoxyl]
- levothyroxine sodium 0.05 MG Oral Tablet [Synthroid]
- levothyroxine sodium 0.05 MG Oral Tablet [Unithroid]
- levothyroxine sodium 0.075 MG Oral Tablet
- levothyroxine sodium 0.075 MG Oral Tablet [Levoxyl]
- levothyroxine sodium 0.075 MG Oral Tablet [Synthroid]
- levothyroxine sodium 0.075 MG Oral Tablet [Unithroid]
- levothyroxine sodium 0.088 MG Oral Tablet
- levothyroxine sodium 0.088 MG Oral Tablet [Levoxyl]
- levothyroxine sodium 0.088 MG Oral Tablet [Synthroid]
- levothyroxine sodium 0.088 MG Oral Tablet [Unithroid]
- levothyroxine sodium 0.1 MG Oral Tablet
- levothyroxine sodium 0.1 MG Oral Tablet [Levoxyl]
- levothyroxine sodium 0.1 MG Oral Tablet [Synthroid]
- levothyroxine sodium 0.1 MG Oral Tablet [Unithroid]
- levothyroxine sodium 0.112 MG Oral Tablet
- levothyroxine sodium 0.112 MG Oral Tablet [Levoxyl]
- levothyroxine sodium 0.112 MG Oral Tablet [Synthroid]
- levothyroxine sodium 0.112 MG Oral Tablet [Unithroid]
- levothyroxine sodium 0.125 MG Oral Tablet
- levothyroxine sodium 0.125 MG Oral Tablet [Levoxyl]
- levothyroxine sodium 0.125 MG Oral Tablet [Synthroid]
- levothyroxine sodium 0.125 MG Oral Tablet [Unithroid]
- levothyroxine sodium 0.137 MG Oral Tablet
- levothyroxine sodium 0.137 MG Oral Tablet [Levoxyl]
- levothyroxine sodium 0.137 MG Oral Tablet [Synthroid]
- levothyroxine sodium 0.15 MG Oral Tablet
- levothyroxine sodium 0.15 MG Oral Tablet [Levoxyl]
- levothyroxine sodium 0.15 MG Oral Tablet [Synthroid]
- levothyroxine sodium 0.175 MG Oral Tablet
- levothyroxine sodium 0.175 MG Oral Tablet [Levoxyl]
- levothyroxine sodium 0.175 MG Oral Tablet [Synthroid]
- levothyroxine sodium 0.2 MG Oral Tablet
- levothyroxine sodium 0.2 MG Oral Tablet [Levoxyl]
- levothyroxine sodium 0.2 MG Oral Tablet [Synthroid]