imiquimod cream / cream pump

Antiviral

Also known as: Zyclara
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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: Mar 18, 2026  ·  Checked: 11 hours, 24 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Aetna Medicare Signature (HMO)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Aetna Medicare Dual (HMO D-SNP)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Aetna Medicare Signature (HMO)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Aetna Medicare Value Plus (HMO)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Aetna Medicare Prime (HMO)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Aetna Medicare Signature Care (HMO)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Aetna Medicare Full Dual Care (HMO D-SNP)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Aetna Medicare Enhanced (HMO)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Aetna Medicare Signature (PPO)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Aetna Medicare Enhanced (PPO)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Aetna Medicare Enhanced (PPO)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Aetna Medicare Signature Extra (PPO)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Aetna Medicare Signature (PPO)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Aetna Medicare Signature (PPO)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Aetna Medicare Signature Giveback (PPO)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Aetna Medicare Signature (PPO)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Aetna Medicare Chronic Care (HMO C-SNP)
via Zyclara 		Tier 5 - Specialty — — ✓ 7.50 per 28 days QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 11 hours, 24 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Non-Preferred — — — None
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