Altabax
Generic: retapamulin
0.01 MG — Ointment
Also known as:
retapamulin
Altabax External Ointment
Compare Prices
Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | — | ✓ | — | ST |
| AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | — | ✓ | — | ST |
| AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | — | ✓ | — | ST |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | — | ✓ | — | ST |
| AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | — | ✓ | — | ST |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 4 - Non-Preferred | — | ✓ | — | ST |
| AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | — | ✓ | — | ST |
| AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | — | ✓ | — | ST |
| AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | — | ✓ | — | ST |
| AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | — | ✓ | — | ST |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Connect Silver RD 5000 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | — | None |
| Connect Silver RD CMS Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Connect Silver RD 2200 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | — | None |
| Connect Gold RD CMS Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Connect Silver 3600 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | — | None |
| Connect Bronze 5500 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | — | None |
| Connect Gold CMS Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Connect myDiabetesCare Silver | Tier 4 - Non-Preferred | — | — | — | None |
| Connect Bronze 7000 HSA Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | — | None |
| Connect Bronze CMS Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Connect myDiabetesCare Bronze | Tier 4 - Non-Preferred | — | — | — | None |
| Connect Silver 5000 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | — | None |
| Connect Silver 3000 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | — | None |
| Connect Silver CMS Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Connect Gold 1500 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | — | None |
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | — | None |
| Connect Bronze RD CMS Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Connect Silver RD 3500 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | — | None |
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | — | None |
| Connect Bronze 6500 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | — | None |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Gold Classic Standard | with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Secure | with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Silver Classic | Tier 3 - Preferred Brand | — | — | — | None |
| Gold Classic Standard | Tier 3 - Preferred Brand | — | — | — | None |
| Bronze Elite + PCP Saver Plus | Tier 3 - Preferred Brand | — | — | — | None |
| Bronze Classic 4700 | with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Silver Classic | with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Silver Simple Diabetes | with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Silver Simple PCP Saver | with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Gold Elite Saver Plus | with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Bronze Simple Diabetes | with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| AIAN Cost Share | Tier 3 - Preferred Brand | — | — | — | None |
| AIAN Cost Share | with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Silver Classic Standard | Tier 3 - Preferred Brand | — | — | — | None |
| Bronze Classic Standard | Tier 3 - Preferred Brand | — | — | — | None |
| Silver Simple Diabetes | Tier 3 - Preferred Brand | — | — | — | None |
| Gold Elite Saver Plus | Tier 3 - Preferred Brand | — | — | — | None |
| Silver Simple PCP Saver | Tier 3 - Preferred Brand | — | — | — | None |
| Bronze Classic 4700 | Tier 3 - Preferred Brand | — | — | — | None |
| Secure | Tier 3 - Preferred Brand | — | — | — | None |
| Bronze Classic Standard | with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Silver Classic Standard | with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |