Acne-Clear

Generic: benzoyl peroxide

0.1 MG — Gel

Also known as: benzoyl peroxide

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

Ambetter (Centene)

174 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 20 hours, 28 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Standard Gold with Atrium Health	Tier 2 - Generic	—	—	—	None
Clear Silver with $0 Insulin Options via Neuac	Tier 2 - Generic	✓	—	—	PA
Standard Expanded Bronze via Neuac	Tier 2 - Generic	✓	—	—	PA
Standard Silver via Neuac	Tier 2 - Generic	✓	—	—	PA
Standard Gold via Neuac	Tier 2 - Generic	✓	—	—	PA
Everyday Bronze with Atrium Health via Neuac	Tier 2 - Generic	✓	—	—	PA
Elite Bronze with Atrium Health via Neuac	Tier 2 - Generic	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Neuac	Tier 2 - Generic	✓	—	—	PA
Complete Gold + Vision + Adult Dental via Neuac	Tier 2 - Generic	✓	—	—	PA
Everyday Bronze + Vision + Adult Dental via Neuac	Tier 2 - Generic	✓	—	—	PA
Elite Bronze + Vision + Adult Dental via Neuac	Tier 2 - Generic	✓	—	—	PA
Everyday Bronze with Atrium Health + Vision + Adult Dental via Neuac	Tier 2 - Generic	✓	—	—	PA
Elite Bronze with Atrium Health + Vision + Adult Dental via Neuac	Tier 2 - Generic	✓	—	—	PA
Focused Silver with Atrium Health + Vision + Adult Dental via Neuac	Tier 2 - Generic	✓	—	—	PA
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via Neuac	Tier 2 - Generic	✓	—	—	PA
Standard Silver with Atrium Health + Vision + Adult Dental via Neuac	Tier 2 - Generic	✓	—	—	PA
Standard Gold with Atrium Health + Vision + Adult Dental via Neuac	Tier 2 - Generic	✓	—	—	PA
Complete Gold via Benzefoam	Tier 2 - Generic	—	—	—	None
Everyday Bronze with Atrium Health via Persa-Gel	Tier 2 - Generic	—	—	—	None
Standard Gold via Persa-Gel	Tier 2 - Generic	—	—	—	None
Standard Silver via Persa-Gel	Tier 2 - Generic	—	—	—	None
Standard Gold with Atrium Health + Vision + Adult Dental via Persa-Gel	Tier 2 - Generic	—	—	—	None
Standard Silver with Atrium Health + Vision + Adult Dental via Persa-Gel	Tier 2 - Generic	—	—	—	None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via Persa-Gel	Tier 2 - Generic	—	—	—	None
Standard Gold with Atrium Health via Persa-Gel	Tier 2 - Generic	—	—	—	None
Standard Silver with Atrium Health via Persa-Gel	Tier 2 - Generic	—	—	—	None
Complete Gold via Neuac	Tier 2 - Generic	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Neuac	Tier 2 - Generic	✓	—	—	PA
Everyday Bronze via Neuac	Tier 2 - Generic	✓	—	—	PA
Elite Bronze via Neuac	Tier 2 - Generic	✓	—	—	PA
Focused Silver with Atrium Health via Neuac	Tier 2 - Generic	✓	—	—	PA
Complete Gold with Atrium Health via Neuac	Tier 2 - Generic	✓	—	—	PA
Standard Expanded Bronze with Atrium Health via Neuac	Tier 2 - Generic	✓	—	—	PA
Standard Silver with Atrium Health via Neuac	Tier 2 - Generic	✓	—	—	PA
Standard Gold with Atrium Health via Neuac	Tier 2 - Generic	✓	—	—	PA
Complete Gold with Atrium Health + Vision + Adult Dental via Neuac	Tier 2 - Generic	✓	—	—	PA
Standard Expanded Bronze + Vision + Adult Dental via Neuac	Tier 2 - Generic	✓	—	—	PA
Standard Silver + Vision + Adult Dental via Neuac	Tier 2 - Generic	✓	—	—	PA
Standard Gold + Vision + Adult Dental via Neuac	Tier 2 - Generic	✓	—	—	PA
Complete Gold	Tier 2 - Generic	—	—	—	None
Enhanced Asthma/COPD Care Silver with $0 Drug Options	Tier 2 - Generic	—	—	—	None
Everyday Bronze	Tier 2 - Generic	—	—	—	None
Elite Bronze	Tier 2 - Generic	—	—	—	None
Clear Silver with $0 Insulin Options	Tier 2 - Generic	—	—	—	None
Standard Expanded Bronze	Tier 2 - Generic	—	—	—	None
Standard Silver	Tier 2 - Generic	—	—	—	None
Standard Gold	Tier 2 - Generic	—	—	—	None
Everyday Bronze with Atrium Health	Tier 2 - Generic	—	—	—	None
Elite Bronze with Atrium Health	Tier 2 - Generic	—	—	—	None
Focused Silver with Atrium Health	Tier 2 - Generic	—	—	—	None
Complete Gold with Atrium Health	Tier 2 - Generic	—	—	—	None
Standard Expanded Bronze with Atrium Health	Tier 2 - Generic	—	—	—	None
Standard Silver with Atrium Health	Tier 2 - Generic	—	—	—	None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Complete Gold + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Everyday Bronze + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Elite Bronze + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Everyday Bronze with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Elite Bronze with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Focused Silver with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Complete Gold with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Standard Expanded Bronze + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Standard Silver + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Standard Gold + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Standard Silver with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Standard Gold with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Standard Expanded Bronze via Persa-Gel	Tier 2 - Generic	—	—	—	None
Elite Bronze with Atrium Health via Persa-Gel	Tier 2 - Generic	—	—	—	None
Focused Silver with Atrium Health via Persa-Gel	Tier 2 - Generic	—	—	—	None
Complete Gold with Atrium Health via Persa-Gel	Tier 2 - Generic	—	—	—	None
Standard Expanded Bronze with Atrium Health via Persa-Gel	Tier 2 - Generic	—	—	—	None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Persa-Gel	Tier 2 - Generic	—	—	—	None
Complete Gold + Vision + Adult Dental via Persa-Gel	Tier 2 - Generic	—	—	—	None
Everyday Bronze + Vision + Adult Dental via Persa-Gel	Tier 2 - Generic	—	—	—	None
Complete Gold via Persa-Gel	Tier 2 - Generic	—	—	—	None
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Persa-Gel	Tier 2 - Generic	—	—	—	None
Everyday Bronze via Persa-Gel	Tier 2 - Generic	—	—	—	None
Elite Bronze via Persa-Gel	Tier 2 - Generic	—	—	—	None
Clear Silver with $0 Insulin Options via Persa-Gel	Tier 2 - Generic	—	—	—	None
Elite Bronze + Vision + Adult Dental via Persa-Gel	Tier 2 - Generic	—	—	—	None
Everyday Bronze with Atrium Health + Vision + Adult Dental via Persa-Gel	Tier 2 - Generic	—	—	—	None
Elite Bronze with Atrium Health + Vision + Adult Dental via Persa-Gel	Tier 2 - Generic	—	—	—	None
Focused Silver with Atrium Health + Vision + Adult Dental via Persa-Gel	Tier 2 - Generic	—	—	—	None
Complete Gold with Atrium Health + Vision + Adult Dental via Persa-Gel	Tier 2 - Generic	—	—	—	None
Standard Expanded Bronze + Vision + Adult Dental via Persa-Gel	Tier 2 - Generic	—	—	—	None
Standard Silver + Vision + Adult Dental via Persa-Gel	Tier 2 - Generic	—	—	—	None
Standard Gold + Vision + Adult Dental via Persa-Gel	Tier 2 - Generic	—	—	—	None
Standard Gold with Atrium Health + Vision + Adult Dental via Benzefoam	Tier 2 - Generic	—	—	—	None
Standard Silver with Atrium Health + Vision + Adult Dental via Benzefoam	Tier 2 - Generic	—	—	—	None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via Benzefoam	Tier 2 - Generic	—	—	—	None
Standard Gold + Vision + Adult Dental via Benzefoam	Tier 2 - Generic	—	—	—	None
Standard Silver + Vision + Adult Dental via Benzefoam	Tier 2 - Generic	—	—	—	None
Standard Expanded Bronze + Vision + Adult Dental via Benzefoam	Tier 2 - Generic	—	—	—	None
Complete Gold with Atrium Health + Vision + Adult Dental via Benzefoam	Tier 2 - Generic	—	—	—	None
Focused Silver with Atrium Health + Vision + Adult Dental via Benzefoam	Tier 2 - Generic	—	—	—	None
Elite Bronze with Atrium Health + Vision + Adult Dental via Benzefoam	Tier 2 - Generic	—	—	—	None
Everyday Bronze with Atrium Health + Vision + Adult Dental via Benzefoam	Tier 2 - Generic	—	—	—	None
Elite Bronze + Vision + Adult Dental via Benzefoam	Tier 2 - Generic	—	—	—	None
Everyday Bronze + Vision + Adult Dental via Benzefoam	Tier 2 - Generic	—	—	—	None
Complete Gold + Vision + Adult Dental via Benzefoam	Tier 2 - Generic	—	—	—	None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Benzefoam	Tier 2 - Generic	—	—	—	None
Standard Gold with Atrium Health via Benzefoam	Tier 2 - Generic	—	—	—	None
Standard Silver with Atrium Health via Benzefoam	Tier 2 - Generic	—	—	—	None
Standard Expanded Bronze with Atrium Health via Benzefoam	Tier 2 - Generic	—	—	—	None
Complete Gold with Atrium Health via Benzefoam	Tier 2 - Generic	—	—	—	None
Focused Silver with Atrium Health via Benzefoam	Tier 2 - Generic	—	—	—	None
Elite Bronze with Atrium Health via Benzefoam	Tier 2 - Generic	—	—	—	None
Everyday Bronze with Atrium Health via Benzefoam	Tier 2 - Generic	—	—	—	None
Standard Gold via Benzefoam	Tier 2 - Generic	—	—	—	None
Standard Silver via Benzefoam	Tier 2 - Generic	—	—	—	None
Standard Expanded Bronze via Benzefoam	Tier 2 - Generic	—	—	—	None
Clear Silver with $0 Insulin Options via Benzefoam	Tier 2 - Generic	—	—	—	None
Elite Bronze via Benzefoam	Tier 2 - Generic	—	—	—	None
Everyday Bronze via Benzefoam	Tier 2 - Generic	—	—	—	None
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Benzefoam	Tier 2 - Generic	—	—	—	None
Complete Gold via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Everyday Bronze via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Elite Bronze via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Clear Silver with $0 Insulin Options via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Standard Expanded Bronze via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Standard Silver via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Standard Gold via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Everyday Bronze with Atrium Health via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Elite Bronze with Atrium Health via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Focused Silver with Atrium Health via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Complete Gold with Atrium Health via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Standard Expanded Bronze with Atrium Health via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Standard Silver with Atrium Health via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Standard Gold with Atrium Health via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Complete Gold + Vision + Adult Dental via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Everyday Bronze + Vision + Adult Dental via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Elite Bronze + Vision + Adult Dental via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Everyday Bronze with Atrium Health + Vision + Adult Dental via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Elite Bronze with Atrium Health + Vision + Adult Dental via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Focused Silver with Atrium Health + Vision + Adult Dental via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Complete Gold with Atrium Health + Vision + Adult Dental via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Standard Expanded Bronze + Vision + Adult Dental via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Standard Silver + Vision + Adult Dental via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Standard Gold + Vision + Adult Dental via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Standard Silver with Atrium Health + Vision + Adult Dental via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Standard Gold with Atrium Health + Vision + Adult Dental via Benzepro	Tier 3 - Preferred Brand	—	—	—	None
Complete Gold + Vision + Adult Dental via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Everyday Bronze + Vision + Adult Dental via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Elite Bronze with Atrium Health + Vision + Adult Dental via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Elite Bronze + Vision + Adult Dental via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Everyday Bronze with Atrium Health + Vision + Adult Dental via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Complete Gold via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Enhanced Asthma/COPD Care Silver with $0 Drug Options via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Everyday Bronze via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Elite Bronze via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Standard Silver + Vision + Adult Dental via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Standard Expanded Bronze + Vision + Adult Dental via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Complete Gold with Atrium Health + Vision + Adult Dental via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Focused Silver with Atrium Health + Vision + Adult Dental via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Clear Silver with $0 Insulin Options via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Standard Expanded Bronze via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Standard Silver via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Standard Gold via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Everyday Bronze with Atrium Health via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Elite Bronze with Atrium Health via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Focused Silver with Atrium Health via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Complete Gold with Atrium Health via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Standard Gold with Atrium Health + Vision + Adult Dental via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Standard Silver with Atrium Health + Vision + Adult Dental via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Standard Gold + Vision + Adult Dental via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Standard Expanded Bronze with Atrium Health via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Standard Silver with Atrium Health via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Standard Gold with Atrium Health via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	—	None

AmeriHealth Caritas NC

10 plans

Source: CMS QHP JSON · Checked: 20 hours, 28 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals via benzoyl peroxide	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Bronze Essential + No Referrals via benzoyl peroxide	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Bronze Signature + No Referrals via benzoyl peroxide	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Silver Signature + No Referrals via benzoyl peroxide	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Gold Signature + No Referrals via benzoyl peroxide	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals via benzoyl peroxide	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Bronze Premier + No Referrals via benzoyl peroxide	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Silver Premier + No Referrals via benzoyl peroxide	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Silver Essential + No Referrals via benzoyl peroxide	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Gold Premier + No Referrals via benzoyl peroxide	Tier 2 - Generic	—	—	—	None

Blue Cross Blue Shield Federal

5 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 20 hours, 28 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Focus 2026 via Neuac	Tier 1 - Generic	—	—	—	None
BCBS Federal Basic Option 2026 via Neuac	Tier 1 - Generic	—	—	—	None
BCBS Federal Standard Option 2026 via Neuac	Tier 1 - Generic	—	—	—	None
BCBS Federal Standard Option 2026 via Epiduo	Tier 3 - Non-Preferred Brand	✓	—	—	PA
BCBS Federal Basic Option 2026 via Epiduo	Tier 3 - Non-Preferred Brand	✓	—	—	PA

Cigna

20 plans

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 20 hours, 28 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect Bronze RD CMS Standard via Neuac	Tier 2 - Generic	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible via Neuac	Tier 2 - Generic	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible via Neuac	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible via Neuac	Tier 2 - Generic	—	—	—	None
Connect Silver 3500 Indiv Med Deductible via Neuac	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible via Neuac	Tier 2 - Generic	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible via Neuac	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Bronze via Neuac	Tier 2 - Generic	—	—	—	None
Connect Gold 1500 Indiv Med Deductible via Neuac	Tier 2 - Generic	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible via Neuac	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Silver via Neuac	Tier 2 - Generic	—	—	—	None
Connect Silver 3000 Indiv Med Deductible via Neuac	Tier 2 - Generic	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible via Neuac	Tier 2 - Generic	—	—	—	None
Connect Silver 4400 Indiv Med Deductible via Neuac	Tier 2 - Generic	—	—	—	None
Connect Gold CMS Standard via Neuac	Tier 2 - Generic	—	—	—	None
Connect Silver RD CMS Standard via Neuac	Tier 2 - Generic	—	—	—	None
Connect Silver CMS Standard via Neuac	Tier 2 - Generic	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible via Neuac	Tier 2 - Generic	—	—	—	None
Connect Bronze CMS Standard via Neuac	Tier 2 - Generic	—	—	—	None
Connect Gold RD CMS Standard via Neuac	Tier 2 - Generic	—	—	—	None

Medicare Part D

56 plans

Source: CMS QHP JSON · Formulary date: Jun 10, 2026 · Checked: 20 hours, 28 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Wellcare Dual Access (HMO-POS D-SNP) via Neuac	Tier 2 - Generic	—	—	✓ 45 per 30 days	QL
Wellcare Dual Liberty (HMO-POS D-SNP) via Neuac	Tier 2 - Generic	—	—	✓ 45 per 30 days	QL
Wellcare Dual Reserve (HMO-POS D-SNP) via Neuac	Tier 2 - Generic	—	—	✓ 45 per 30 days	QL
Wellcare Dual Liberty Open (PPO D-SNP) via Neuac	Tier 2 - Generic	—	—	✓ 45 per 30 days	QL
Wellcare Assist Open (PPO) via Neuac	Tier 2 - Generic	—	—	✓ 45 per 30 days	QL
DEVOTED DUAL 009 NC (HMO D-SNP) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED CORE 001 NC (HMO) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED GIVEBACK 002 NC (HMO) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED GIVEBACK 012 NC (HMO) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED CHOICE 001 NC (PPO) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED CHOICE 005 NC (PPO) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED CHOICE 008 NC (PPO) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED CHOICE GIVEBACK 009 NC (PPO) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED CHOICE 003 NC (PPO) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED CHOICE GIVEBACK 004 NC (PPO) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) via Neuac	Tier 3 - Preferred Brand	—	—	✓ 45 per 30 days	QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
Erickson Advantage Liberty (HMO-POS) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
Erickson Advantage Freedom (HMO-POS) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
Erickson Advantage Guardian (HMO-POS I-SNP) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
Erickson Advantage Signature (HMO-POS) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage from UHC NC-26 (HMO-POS) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage from UHC NC-24 (HMO-POS) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
UHC Dual Complete NC-S3 (HMO-POS D-SNP) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
UHC Dual Complete NC-V001 (HMO-POS D-SNP) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage from UHC NC-0019 (PPO) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage from UHC NC-0017 (PPO) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage from UHC NC-0016 (PPO) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage from UHC NC-0004 (PPO) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage from UHC NC-0001 (PPO) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage Access from UHC NC-23 (PPO) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
UHC Dual Complete NC-S2 (PPO D-SNP) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
UHC Dual Complete NC-S001 (PPO D-SNP) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
UHC Nursing Home Plan NC-F001 (PPO I-SNP) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
Erickson Advantage Champion (HMO-POS C-SNP) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
UHC Complete Care NC-28 (HMO-POS C-SNP) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
UHC Complete Care NC-27 (HMO-POS C-SNP) via Neuac	Tier 4 - Non-Preferred	—	—	—	None
UHC Complete Care NC-25 (HMO-POS C-SNP) via Neuac	Tier 4 - Non-Preferred	—	—	—	None

NC Medicaid PDL

2 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 20 hours, 28 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Epsolay	Non-Preferred	—	—	—	None
NC Medicaid Preferred Drug List 2026 via Neuac Gel	Non-Preferred	—	—	—	None

NC State Health Plan

6 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 20 hours, 28 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 via Neuac	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - HDHP 2026 via Neuac	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Neuac	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Epiduo	Tier 2 - Non-Preferred Generic	✓	✓	—	PA \| ST
NC State Health Plan - 70/30 Standard PPO 2026 via Epiduo	Tier 2 - Non-Preferred Generic	✓	✓	—	PA \| ST
NC State Health Plan - HDHP 2026 via Epiduo	Tier 2 - Non-Preferred Generic	✓	✓	—	PA \| ST

Oscar Health

28 plans

Source: CMS QHP JSON · Checked: 20 hours, 28 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Silver Simple Diabetes \| with Atrium Health via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Silver Simple PCP Saver \| with Atrium Health via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Gold Elite Saver Plus \| with Atrium Health via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Bronze Classic 4700 via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Bronze Simple Diabetes \| with Atrium Health via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Silver Simple Chronic Care CKM \| with Atrium Health via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
AIAN Cost Share via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
AIAN Cost Share \| with Atrium Health via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Silver Classic Standard \| with Atrium Health via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Bronze Classic Standard \| with Atrium Health via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Gold Classic Standard via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Silver Classic Standard via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Bronze Classic Standard via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Bronze Simple Chronic Care CKM \| with Atrium Health via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Silver Simple PCP Saver via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Gold Elite Saver Plus via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Silver Simple Diabetes via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Secure \| with Atrium Health via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Bronze Classic 4700 \| with Atrium Health via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Bronze Elite + PCP Saver Plus \| with Atrium Health via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Silver Classic \| with Atrium Health via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Gold Classic Standard \| with Atrium Health via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Bronze Elite + PCP Saver Plus via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Silver Classic via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL
Secure via benzoyl peroxide	Tier 2 - Generic	—	—	✓	QL

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jun 24, 2026 · Checked: 20 hours, 28 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via benzoyl peroxide	Tier 3 - Non-Formulary	✓	—	—	PA

UnitedHealthcare

13 plans

Source: PDF · Formulary date: Jun 23, 2026 · Checked: 20 hours, 28 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	✓	QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	✓	QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	✓	QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	✓	QL
UHC Bronze Standard+ Dental + Vision (No Referrals) via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	✓	QL
UHC Gold Standard (No Referrals) via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	✓	QL
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	✓	QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	✓	QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	✓	QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	✓	QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	✓	QL
UHC Bronze Standard (No Referrals) via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	✓	QL
UHC Silver Standard (No Referrals) via benzoyl peroxide	Tier 3 - Preferred Brand	—	—	✓	QL