Eskata

Generic: hydrogen peroxide

40% — Solution

Dermatological Agents

Also known as: ESKATA SOLN 40% hydrogen peroxide

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: Jul 1, 2026  ·  Checked: 11 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via hydrogen peroxide
Tier 3 - Non-Preferred Brand None
NC State Health Plan - HDHP 2026
via hydrogen peroxide
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 70/30 Standard PPO 2026
via hydrogen peroxide
Tier 3 - Non-Preferred Brand None
NC State Health Plan - HDHP 2026 Not Covered None
NC State Health Plan - 70/30 Standard PPO 2026 Not Covered None
NC State Health Plan - 80/20 Plus PPO 2026 Not Covered None
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 11 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via hydrogen peroxide
Tier 0 - $0 Preventive None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via hydrogen peroxide
Tier 0 - $0 Preventive None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via hydrogen peroxide
Tier 0 - $0 Preventive None
UHC Gold Standard (No Referrals)
via hydrogen peroxide
Tier 0 - $0 Preventive None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via hydrogen peroxide
Tier 0 - $0 Preventive None
UHC Silver Standard (No Referrals)
via hydrogen peroxide
Tier 0 - $0 Preventive None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via hydrogen peroxide
Tier 0 - $0 Preventive None
UHC Bronze Standard (No Referrals)
via hydrogen peroxide
Tier 0 - $0 Preventive None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via hydrogen peroxide
Tier 0 - $0 Preventive None
UHC Bronze Standard+ Dental + Vision (No Referrals)
via hydrogen peroxide
Tier 0 - $0 Preventive None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via hydrogen peroxide
Tier 0 - $0 Preventive None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via hydrogen peroxide
Tier 0 - $0 Preventive None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via hydrogen peroxide
Tier 0 - $0 Preventive None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, 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 Value ($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 Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred None
UHC Silver Standard (No Referrals) Tier 4 - Non-Preferred None
UHC Bronze Standard (No Referrals) Tier 4 - Non-Preferred None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals Tier 4 - Non-Preferred None
UHC Gold 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 Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, 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+ Dental + Vision (No Referrals) Tier 4 - Non-Preferred None
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