Hemmorex-Hc

Generic: hydrocortisone acetate

25 Mg — Suppository

Corticosteroid

Also known as: Hemmorex-Hc 25 Mg Suppository Hemmorex-Hc 30 Mg Suppository
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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: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 2 hours, 18 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Enhanced CHF Heart Care Silver $0 Rx Options
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Enhanced Asthma/COPD Care Silver $0 Rx Options
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Everyday Bronze
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Elite Bronze
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Clear Silver with $0 Insulin Options
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Signature Expanded Bronze
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Signature Silver
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Signature Gold
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Everyday Bronze with Atrium Health
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Elite Bronze with Atrium Health
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Focused Silver with Atrium Health
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Complete Gold with Atrium Health
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Signature Expanded Bronze with Atrium Health
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Signature Silver with Atrium Health
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Signature Gold with Atrium Health
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Complete Gold + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Everyday Bronze + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Elite Bronze + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Focused Silver with Atrium Health + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Complete Gold with Atrium Health + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Signature Expanded Bronze + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Signature Silver + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Signature Gold + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Signature Silver with Atrium Health + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Signature Gold with Atrium Health + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Complete Gold
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Streamlined Silver
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Streamlined Silver with Atrium Health
via hydrocortisone acetate 		Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Oct 7, 2026  ·  Checked: 2 hours, 18 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze 7000 HSA Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze 5500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver 5000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver 3600 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver 3000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze CMS Standard Tier 2 - Generic — — — None
Connect Silver CMS Standard Tier 2 - Generic — — — None
Connect Gold CMS Standard Tier 2 - Generic — — — None
Connect myDiabetesCare Bronze Tier 2 - Generic — — — None
Connect myDiabetesCare Silver Tier 2 - Generic — — — None
Connect Gold 1500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze RD 5000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze RD 6000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze RD CMS Standard Tier 2 - Generic — — — None
Connect Silver RD 3500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver RD 5000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver RD CMS Standard Tier 2 - Generic — — — None
Connect Silver RD 2200 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Gold RD CMS Standard Tier 2 - Generic — — — None
Connect Bronze 6500 Indiv Med Deductible
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Bronze 5500 Indiv Med Deductible
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Silver 5000 Indiv Med Deductible
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Silver 3600 Indiv Med Deductible
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Silver 3000 Indiv Med Deductible
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Bronze CMS Standard
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Silver CMS Standard
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Gold CMS Standard
via Anucort-HC 		Tier 2 - Generic — — — None
Connect myDiabetesCare Bronze
via Anucort-HC 		Tier 2 - Generic — — — None
Connect myDiabetesCare Silver
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Gold 1500 Indiv Med Deductible
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Bronze RD 5000 Indiv Med Deductible
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Bronze RD 6000 Indiv Med Deductible
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Bronze RD CMS Standard
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Silver RD 3500 Indiv Med Deductible
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Silver RD 5000 Indiv Med Deductible
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Silver RD CMS Standard
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Silver RD 2200 Indiv Med Deductible
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Gold RD CMS Standard
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Bronze 7000 HSA Indiv Med Deductible
via Anucort-HC 		Tier 2 - Generic — — — None
Connect Bronze 6500 Indiv Med Deductible Tier 2 - Generic — — — None
Source: Excel (XLSX)  ·  Formulary date: Jul 31, 2026  ·  Checked: 2 hours, 18 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via hydrocortisone acetate 		Tier 1 - Basic Core Formulary — — — None
Source: PDF  ·  Formulary date: Sep 23, 2026  ·  Checked: 2 hours, 18 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)
via hydrocortisone acetate 		Tier 3 - Preferred Brand — — — None
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