diclofenac epolamine ptch 1.3%

1.3%

ANTI-INFLAMMATORY AGENTS - TOPICAL

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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: Oct 1, 2026  ·  Checked: 12 hours, 57 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026 Tier 1 - Generic — — — None
BCBS Federal Standard Option 2026 Tier 1 - Generic — — — None
BCBS Federal Basic Option 2026 Tier 1 - Generic — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 12 hours, 57 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Tier 1 - Preferred Generic ✓ — ✓ PA | QL
NC State Health Plan - HDHP 2026 Tier 1 - Preferred Generic ✓ — ✓ PA | QL
NC State Health Plan - 70/30 Standard PPO 2026 Tier 1 - Preferred Generic ✓ — ✓ PA | QL
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