lidocaine hcl (local anesth.)

5%, 1%, 1.5%, 2%, 4% — Solution

Also known as: lidocaine hcl (local anesth.) soln .5%, 1%, 1.5%, 2%, 4%; sosy 100mg/5ml lidocaine hcl (local anesth.) soln .5%, 1%, 1.5%,

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

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 3 hours, 29 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - HDHP 2026	Tier 1 - Preferred Generic	—	—	—	None