HYDROCORTISONE BUTYR

0.1% — Solution

Corticosteroid

Also known as: Hydrocortisone Butyrate External Solution Hydrocortisone Butyrate Topical Solution
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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: Sep 22, 2026  ·  Checked: 13 hours, 34 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — ✓ — ST
Source: PDF  ·  Formulary date: Oct 15, 2026  ·  Checked: 13 hours, 34 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze 5500 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Gold RD CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 5000 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Bronze Tier 3 - Preferred Brand — — ✓ QL
Connect Gold 1500 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3000 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Silver CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Silver Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3600 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Connect Gold CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 13 hours, 34 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 2 - Generic — — — None
Troy Medicare (HMO) Tier 2 - Generic — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 2 - Generic — — — None
HealthSpring Preferred Savings (HMO) Tier 3 - Preferred Brand — — ✓ 120 per 30 days QL
HealthSpring Preferred Plus (HMO) Tier 3 - Preferred Brand — — ✓ 120 per 30 days QL
HealthSpring TotalCare (HMO D-SNP) Tier 3 - Preferred Brand — — ✓ 120 per 30 days QL
HealthSpring Preferred (HMO) Tier 3 - Preferred Brand — — ✓ 120 per 30 days QL
Alignment Health AVA (PPO) Tier 3 - Preferred Brand — — ✓ 120 per 30 days QL
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 3 - Preferred Brand — — ✓ 120 per 30 days QL
Alignment Health Platinum Select (HMO) Tier 3 - Preferred Brand — — ✓ 120 per 30 days QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 3 - Preferred Brand — — ✓ 120 per 30 days QL
Alignment Health smartHMO (HMO) Tier 3 - Preferred Brand — — ✓ 120 per 30 days QL
Alignment Health NC Duals (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 120 per 30 days QL
Alignment Health Platinum (HMO) Tier 3 - Preferred Brand — — ✓ 120 per 30 days QL
HealthSpring True Choice (PPO) Tier 3 - Preferred Brand — — ✓ 120 per 30 days QL
HealthSpring TotalCare Plus (HMO D-SNP) Tier 3 - Preferred Brand — — ✓ 120 per 30 days QL
HealthSpring Preferred Select (HMO) Tier 3 - Preferred Brand — — ✓ 120 per 30 days QL
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