Does Moda Health Affinity Bronze HDHP 7500 cover dextromethorphan / guaifenesin / pseudoephedrine?
Moda Health Affinity Bronze HDHP 7500
39424-39424OR1680007-0 · ACA · ACA Marketplace
dextromethorphan / guaifenesin / pseudoephedrine
dextromethorphan / guaifenesin / pseudoephedrineunder Moda Health Affinity Bronze HDHP 7500
Covered — just walk in
Nothing to clear first — take the prescription to an in-network pharmacy.
What you'd pay
$0per 30-day fill
Your plan’s deductible comes first — you pay the full price until it is met.
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
- Preferred brand
- Approval first
- Not needed
- Try another first
- No
- 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 (3)
- dextromethorphan hydrobromide 15 MG / guaifenesin 400 MG / pseudoephedrine hydrochloride 60 MG Oral TabletAmount limit
- dextromethorphan hydrobromide 2 MG/ML / guaifenesin 37.4 MG/ML / pseudoephedrine hydrochloride 6 MG/ML Oral SolutionAmount limit
- dextromethorphan hydrobromide 3 MG/ML / guaifenesin 40 MG/ML / pseudoephedrine hydrochloride 6 MG/ML Oral SolutionAmount limit
← All coverage for dextromethorphan / guaifenesin / pseudoephedrine