Does NH Local Choice HMO Gold + $0 Rx list + $0 Virtual Urgent Care cover glycerin / polyethylene glycol 400 / hypromellose?
NH Local Choice HMO Gold + $0 Rx list + $0 Virtual Urgent Care
59025-59025NH0370103-0 · ACA · ACA Marketplace
glycerin / polyethylene glycol 400 / hypromellose
glycerin / polyethylene glycol 400 / hypromelloseunder NH Local Choice HMO Gold + $0 Rx list + $0 Virtual Urgent Care
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
- Preferred 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.