ciprofloxacin solution

Drops

Antibiotics

Also known as: Ciloxan
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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: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 21 hours, 37 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze CMS Standard
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect Gold RD CMS Standard
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect myDiabetesCare Silver
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect Silver RD 2200 Indiv Med Deductible
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect Gold 1500 Indiv Med Deductible
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect myDiabetesCare Bronze
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect Bronze 5500 Indiv Med Deductible
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD 6000 Indiv Med Deductible
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect Silver 3500 Indiv Med Deductible
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD 5000 Indiv Med Deductible
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect Silver RD 3500 Indiv Med Deductible
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect Bronze 7000 HSA Indiv Med Deductible
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect Silver 4400 Indiv Med Deductible
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect Silver RD 5000 Indiv Med Deductible
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect Silver 3000 Indiv Med Deductible
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect Bronze 6500 Indiv Med Deductible
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect Silver CMS Standard
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect Silver RD CMS Standard
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect Gold CMS Standard
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD CMS Standard
via Ciloxan 		Tier 4 - Non-Preferred — — — None
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 21 hours, 37 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL 009 NC (HMO D-SNP)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
DEVOTED CORE 001 NC (HMO)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 002 NC (HMO)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 012 NC (HMO)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 001 NC (PPO)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 003 NC (PPO)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 005 NC (PPO)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 008 NC (PPO)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature (HMO)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Dual (HMO D-SNP)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
Aetna Medicare Signature (HMO)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
Aetna Medicare Value Plus (HMO)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
Aetna Medicare Prime (HMO)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
Aetna Medicare Signature Care (HMO)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
Aetna Medicare Full Dual Care (HMO D-SNP)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
Aetna Medicare Enhanced (HMO)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
Aetna Medicare Signature (PPO)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
Aetna Medicare Enhanced (PPO)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
Aetna Medicare Enhanced (PPO)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
Aetna Medicare Signature Extra (PPO)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
Aetna Medicare Signature (PPO)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
Aetna Medicare Signature (PPO)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
Aetna Medicare Signature Giveback (PPO)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
Aetna Medicare Signature (PPO)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
Aetna Medicare Chronic Care (HMO C-SNP)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Ciloxan 		Tier 3 - Preferred Brand — — ✓ 42 per 30 days QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Ciloxan 		Tier 3 - Preferred Brand — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 21 hours, 37 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Preferred — — — None
NC Medicaid Preferred Drug List 2026
via Ciloxan 		Non-Preferred — — — None
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