FillMapImperial Standard Silver

Does Imperial Standard Silver cover levothyroxine?

Imperial Standard Silver
98113-98113UT0010002-0 · ACA · ACA Marketplace
levothyroxine
levothyroxineunder Imperial Standard Silver
Covered — the conditions depend on which form
Not the same for every form: 42 of 113 need your plan’s approval first, and 48 of 113 usually need a preferred medication tried first. Check your exact form in the list below — your doctor’s office handles either.
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.

Amount limit applies — you can still fill it, but your plan caps how much you get at a time. This plan's drug list records the cap without stating the amount — your pharmacy can tell you when they fill it.
Tier
Generic
Approval first
Required
Try another first
Required
Amount limit
Yes
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 (113)

  • levothyroxine sodium 0.013 MG Oral CapsuleApproval first
  • levothyroxine sodium 0.013 MG Oral Capsule [Tirosint]Approval first
  • levothyroxine sodium 0.013 MG/ML Oral Solution [Tirosint]Approval first
  • levothyroxine sodium 0.02 MG/ML Oral Solution [Thyquidity]Try another firstAmount limit
  • levothyroxine sodium 0.025 MG Oral CapsuleApproval first
  • levothyroxine sodium 0.025 MG Oral Capsule [Tirosint]Approval first
  • levothyroxine sodium 0.025 MG Oral Tablet
  • levothyroxine sodium 0.025 MG Oral Tablet [Euthyrox]
  • levothyroxine sodium 0.025 MG Oral Tablet [Levo-T]Try another first
  • levothyroxine sodium 0.025 MG Oral Tablet [Levoxyl]Try another first
  • levothyroxine sodium 0.025 MG Oral Tablet [Synthroid]Try another first
  • levothyroxine sodium 0.025 MG Oral Tablet [Unithroid]Try another first
  • levothyroxine sodium 0.025 MG/ML Oral Solution [Tirosint]Approval first
  • levothyroxine sodium 0.0375 MG Oral Capsule [Tirosint]Approval first
  • levothyroxine sodium 0.0375 MG/ML Oral Solution [Tirosint]Approval first
  • levothyroxine sodium 0.044 MG Oral Capsule [Tirosint]Approval first
  • levothyroxine sodium 0.044 MG/ML Oral Solution [Tirosint]Approval first
  • levothyroxine sodium 0.05 MG Oral CapsuleApproval first
  • levothyroxine sodium 0.05 MG Oral Capsule [Tirosint]Approval first
  • levothyroxine sodium 0.05 MG Oral Tablet
  • levothyroxine sodium 0.05 MG Oral Tablet [Euthyrox]
  • levothyroxine sodium 0.05 MG Oral Tablet [Levo-T]Try another first
  • levothyroxine sodium 0.05 MG Oral Tablet [Levoxyl]Try another first
  • levothyroxine sodium 0.05 MG Oral Tablet [Synthroid]Try another first
  • levothyroxine sodium 0.05 MG Oral Tablet [Unithroid]Try another first
  • levothyroxine sodium 0.05 MG/ML Oral Solution [Tirosint]Approval first
  • levothyroxine sodium 0.0625 MG Oral Capsule [Tirosint]Approval first
  • levothyroxine sodium 0.0625 MG/ML Oral Solution [Tirosint]Approval first
  • levothyroxine sodium 0.075 MG Oral CapsuleApproval first
  • levothyroxine sodium 0.075 MG Oral Capsule [Tirosint]Approval first
  • levothyroxine sodium 0.075 MG Oral Tablet
  • levothyroxine sodium 0.075 MG Oral Tablet [Euthyrox]
  • levothyroxine sodium 0.075 MG Oral Tablet [Levo-T]Try another first
  • levothyroxine sodium 0.075 MG Oral Tablet [Levoxyl]Try another first
  • levothyroxine sodium 0.075 MG Oral Tablet [Synthroid]Try another first
  • levothyroxine sodium 0.075 MG Oral Tablet [Unithroid]Try another first
  • levothyroxine sodium 0.075 MG/ML Oral Solution [Tirosint]Approval first
  • levothyroxine sodium 0.088 MG Oral CapsuleApproval first
  • levothyroxine sodium 0.088 MG Oral Capsule [Tirosint]Approval first
  • levothyroxine sodium 0.088 MG Oral Tablet

← All coverage for levothyroxine