Flector

Generic: diclofenac epolamine

1.3 % — PATCH TD12

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

1 plan

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 4 hours, 27 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via diclofenac epolamine	Non-Preferred	—	—	—	None

3 plans

Source: Excel (XLSX) · Formulary date: Sep 23, 2026 · Checked: 4 hours, 27 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via diclofenac epolamine	Tier 3 - Non-Formulary	—	—	—	None
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	—	—	—	None
TRICARE Uniform Formulary 2026 via Licart	Tier 3 - Non-Formulary	✓	—	✓ LICART TRANSDERMAL 24 HOURS PATCH TO BE DISP AT A MAX QTY OF 30 PATCHES IN 23 DAYS	PA \| QL PA: 1270/48001/90693 PA DRUGS, DOD PA REQUIRED; Quantity limit