Klaron

Generic: sulfacetamide sodium

ANTIDOTES

GoodRx Compare Prices

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: 9 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Focused Silver with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Enhanced Asthma/COPD Care Silver $0 Rx Options
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Everyday Bronze
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Elite Bronze
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Clear Silver with $0 Insulin Options
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Signature Expanded Bronze
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Signature Silver
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Signature Gold
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Everyday Bronze with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Elite Bronze with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Signature Silver + Vision + Adult Dental
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Signature Gold + Vision + Adult Dental
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Signature Silver with Atrium Health + Vision + Adult Dental
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Signature Gold with Atrium Health + Vision + Adult Dental
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Complete Gold
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Streamlined Silver
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Streamlined Silver with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Enhanced CHF Heart Care Silver $0 Rx Options
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Complete Gold with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Signature Expanded Bronze with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Signature Silver with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Signature Gold with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Complete Gold + Vision + Adult Dental
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Everyday Bronze + Vision + Adult Dental
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Elite Bronze + Vision + Adult Dental
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Focused Silver with Atrium Health + Vision + Adult Dental
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Complete Gold with Atrium Health + Vision + Adult Dental
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Signature Expanded Bronze + Vision + Adult Dental
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Source: CMS QHP JSON  ·  Formulary date: Sep 22, 2026  ·  Checked: 9 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via sulfacetamide sodium 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via sulfacetamide sodium 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Silver Premier + No Referrals
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 9 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Value 2026 Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Advantage 2026 Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Local 2026 Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Care 2026 Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Advantage 2026
via sulfacetamide sodium 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via sulfacetamide sodium 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Local 2026
via sulfacetamide sodium 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Care 2026
via sulfacetamide sodium 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Value 2026
via sulfacetamide sodium 		Tier 4 - Higher Cost Brand — — — None
Source: CMS QHP JSON  ·  Checked: 9 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Bronze Classic Standard
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Silver Classic Standard
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Gold Classic Standard
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Bronze Classic Standard | with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Silver Classic Standard | with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Gold Classic Standard | with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Bronze Simple Chronic Care CKM | with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Secure | with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Bronze Classic 4700 | with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Bronze Elite + PCP Saver Plus | with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Silver Classic | with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Silver Simple Diabetes | with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Silver Simple PCP Saver | with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Gold Elite Saver Plus | with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Bronze Simple Diabetes | with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Silver Simple Chronic Care CKM | with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — — None
AIAN Cost Share
via sulfacetamide sodium 		Tier 2 - Generic — — — None
AIAN Cost Share | with Atrium Health
via sulfacetamide sodium 		Tier 2 - Generic — — — None
Silver Classic
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Bronze Classic 4700
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Silver Simple PCP Saver
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Gold Elite Saver Plus
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Silver Simple Diabetes
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Bronze Elite + PCP Saver Plus
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Secure
via sulfacetamide sodium 		Tier 2 - Generic — — ✓ QL
Source: Excel (XLSX)  ·  Formulary date: Jul 31, 2026  ·  Checked: 9 hours, 55 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via sulfacetamide sodium 		Tier 1 - Basic Core Formulary — — — None
Source: PDF  ·  Formulary date: Sep 23, 2026  ·  Checked: 9 hours, 55 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals)
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)
via sulfacetamide sodium 		Tier 4 - Non-Preferred — — — None
Something not right?