Analpram Hc

Generic: pramoxine

2.5% — Cream

RECTAL COMBINATIONS

Also known as: ANALPRAM HC CRE 1-1% ANALPRAM HC CRE 2.5-1% ANALPRAM HC LOT 2.5% hydrocortisone acetate
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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 15 hours, 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Complete Gold
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Standard Gold + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Everyday Bronze
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Elite Bronze
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Clear Silver with $0 Insulin Options
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Standard Expanded Bronze
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Standard Silver
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Standard Gold
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Everyday Bronze with Atrium Health
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Elite Bronze with Atrium Health
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Focused Silver with Atrium Health
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Complete Gold with Atrium Health
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Standard Expanded Bronze with Atrium Health
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Standard Silver with Atrium Health
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Standard Gold with Atrium Health
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Complete Gold + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Everyday Bronze + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Elite Bronze + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Focused Silver with Atrium Health + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Complete Gold with Atrium Health + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Standard Expanded Bronze + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Standard Silver + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Standard Silver with Atrium Health + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Standard Gold with Atrium Health + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 15 hours, 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026
via Proctofoam 		Tier 2 - Preferred Brand — — — None
BCBS Federal Focus 2026
via Epifoam 		Tier 2 - Preferred Brand — — — None
BCBS Federal Focus 2026
via Proctofoam 		Tier 2 - Preferred Brand — — — None
BCBS Federal Basic Option 2026
via Epifoam 		Tier 2 - Preferred Brand — — — None
BCBS Federal Standard Option 2026
via Proctofoam 		Tier 2 - Preferred Brand — — — None
BCBS Federal Standard Option 2026
via Epifoam 		Tier 2 - Preferred Brand — — — None
BCBS Federal Standard Option 2026
via Pramosone 		Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Basic Option 2026 Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Basic Option 2026
via Pramosone 		Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Standard Option 2026 Tier 3 - Non-Preferred Brand — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 15 hours, 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Silver RD 3500 Indiv Med Deductible
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD 5000 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Silver RD 3500 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Bronze 7000 HSA Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Silver 4400 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Silver RD 5000 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Silver 3000 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Bronze 6500 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Silver CMS Standard
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Silver RD CMS Standard
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Gold CMS Standard
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD CMS Standard
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Gold RD CMS Standard
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Bronze CMS Standard
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Silver CMS Standard Tier 4 - Non-Preferred — — — None
Connect Silver RD CMS Standard Tier 4 - Non-Preferred — — — None
Connect Gold CMS Standard Tier 4 - Non-Preferred — — — None
Connect Bronze RD CMS Standard Tier 4 - Non-Preferred — — — None
Connect Gold RD CMS Standard Tier 4 - Non-Preferred — — — None
Connect Bronze CMS Standard Tier 4 - Non-Preferred — — — None
Connect myDiabetesCare Silver
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Silver RD 2200 Indiv Med Deductible
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Gold 1500 Indiv Med Deductible
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect myDiabetesCare Bronze
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Bronze 5500 Indiv Med Deductible
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD 6000 Indiv Med Deductible
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Silver 3500 Indiv Med Deductible
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD 5000 Indiv Med Deductible
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Silver RD 3500 Indiv Med Deductible
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Bronze 7000 HSA Indiv Med Deductible
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Silver 4400 Indiv Med Deductible
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Silver RD 5000 Indiv Med Deductible
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Silver 3000 Indiv Med Deductible
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Bronze 6500 Indiv Med Deductible
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Silver CMS Standard
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Silver RD CMS Standard
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Gold CMS Standard
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD CMS Standard
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Gold RD CMS Standard
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect Bronze CMS Standard
via Pramosone 		Tier 4 - Non-Preferred — — — None
Connect myDiabetesCare Silver
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Silver RD 2200 Indiv Med Deductible
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Gold 1500 Indiv Med Deductible
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect myDiabetesCare Bronze
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Bronze 5500 Indiv Med Deductible
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD 6000 Indiv Med Deductible
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Silver 3500 Indiv Med Deductible
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD 5000 Indiv Med Deductible
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Bronze 7000 HSA Indiv Med Deductible
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Silver 4400 Indiv Med Deductible
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Silver RD 5000 Indiv Med Deductible
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Silver 3000 Indiv Med Deductible
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect Bronze 6500 Indiv Med Deductible
via Epifoam 		Tier 4 - Non-Preferred — — — None
Connect myDiabetesCare Silver Tier 4 - Non-Preferred — — — None
Connect Silver RD 2200 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Gold 1500 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect myDiabetesCare Bronze Tier 4 - Non-Preferred — — — None
Connect Bronze 5500 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Bronze RD 6000 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Silver 3500 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 15 hours, 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via Proctofoam 		Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - HDHP 2026
via Proctofoam 		Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Proctofoam 		Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - HDHP 2026
via Pramosone 		Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Pramosone 		Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Pramosone 		Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - HDHP 2026
via Epifoam 		Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Epifoam 		Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Epifoam 		Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - HDHP 2026 Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Tier 3 - Non-Preferred Brand — — — None
Source: Excel (XLSX)  ·  Formulary date: Jun 24, 2026  ·  Checked: 15 hours, 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via hydrocortisone acetate 		Tier 1 - Basic Core Formulary — — — None
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 15 hours, 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Silver Standard (No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Bronze Standard (No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Gold Standard (No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Bronze Standard+ Dental + Vision (No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Silver Standard (No Referrals) Tier 4 - Non-Preferred — — — None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals Tier 4 - Non-Preferred — — — None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Gold Standard (No Referrals) Tier 4 - Non-Preferred — — — None
UHC Bronze Standard+ Dental + Vision (No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Bronze Standard (No Referrals) Tier 4 - Non-Preferred — — — None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred — — — None
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