benzocaine/menthol/zinc/benzal

20 %-0.26% — Cream

Also known as: ORAJEL 4X TOOTHACHE-GUM

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

1 plan

Source: Excel (XLSX) · Formulary date: Oct 29, 2026 · Checked: 3 hours, 52 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via Orajel 4X Toothache-gum	Tier 3 - Non-Formulary	—	—	—	None