lidocaine hcl urethral/mucosal

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

5 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 19 hours, 14 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Advantage 2026 via Lidocaine Hydrochloride J	Tier 4 - Higher Cost Brand	—	—	—	None
BCBSNC Blue Home with UNC Health Alliance 2026 via Lidocaine Hydrochloride J	Tier 4 - Higher Cost Brand	—	—	—	None
BCBSNC Blue Local 2026 via Lidocaine Hydrochloride J	Tier 4 - Higher Cost Brand	—	—	—	None
BCBSNC Blue Care 2026 via Lidocaine Hydrochloride J	Tier 4 - Higher Cost Brand	—	—	—	None
BCBSNC Blue Value 2026 via Lidocaine Hydrochloride J	Tier 4 - Higher Cost Brand	—	—	—	None

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 19 hours, 14 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UnitedHealthcare NC Individual & Family 2026	Tier 2 - Lower Cost	—	—	—	None