loteprednol-tobramycin

Drops

Antibiotics-Steroid Combinations

Also known as: Zylet
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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: Jan 1, 2026  ·  Checked: 3 hours, 20 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Signature Silver with Atrium Health
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Signature Expanded Bronze with Atrium Health
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Complete Gold with Atrium Health
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Focused Silver with Atrium Health + Vision + Adult Dental
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Complete Gold with Atrium Health + Vision + Adult Dental
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Signature Expanded Bronze + Vision + Adult Dental
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Signature Silver + Vision + Adult Dental
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Signature Gold + Vision + Adult Dental
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze + Vision + Adult Dental
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Signature Silver with Atrium Health + Vision + Adult Dental
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Signature Gold with Atrium Health + Vision + Adult Dental
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Complete Gold
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Enhanced Asthma/COPD Care Silver $0 Rx Options
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Clear Silver with $0 Insulin Options
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Signature Expanded Bronze
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Signature Silver
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Signature Gold
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze with Atrium Health
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze with Atrium Health
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Focused Silver with Atrium Health
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Complete Gold + Vision + Adult Dental
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Signature Gold with Atrium Health
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Streamlined Silver
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Streamlined Silver with Atrium Health
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Enhanced CHF Heart Care Silver $0 Rx Options
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze + Vision + Adult Dental
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze with Atrium Health + Vision + Adult Dental
via Zylet 		Tier 4 - Non-Preferred ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Oct 26, 2026  ·  Checked: 3 hours, 20 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Zylet 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Zylet 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Zylet 		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 Zylet 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Silver Premier + No Referrals
via Zylet 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Zylet 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Zylet 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Zylet 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Zylet 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Zylet 		Tier 4 - Non-Preferred — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 3 hours, 20 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026
via Zylet 		Tier 2 - Preferred Brand — — — None
BCBS Federal Basic Option 2026
via Zylet 		Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Standard Option 2026
via Zylet 		Tier 3 - Non-Preferred Brand — — — None
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 3 hours, 20 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Zylet 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Zylet 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Zylet 		Tier 1 - Preferred Generic — — — None
DEVOTED CHOICE 001 NC (PPO)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature (HMO)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Dual (HMO D-SNP)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature (HMO)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Value Plus (HMO)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Prime (HMO)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature Care (HMO)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Full Dual Care (HMO D-SNP)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Chronic Care (HMO C-SNP)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Enhanced (HMO)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED CORE 001 NC (HMO)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 002 NC (HMO)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL 009 NC (HMO D-SNP)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 012 NC (HMO)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature (PPO)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Enhanced (PPO)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Enhanced (PPO)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature Extra (PPO)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature (PPO)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature (PPO)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature Giveback (PPO)
via Zylet 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature (PPO)
via Zylet 		Tier 3 - Preferred Brand — — — None
HealthSpring True Choice (PPO)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 003 NC (PPO)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 005 NC (PPO)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 008 NC (PPO)
via Zylet 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Zylet 		Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare (HMO D-SNP)
via Zylet 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred (HMO)
via Zylet 		Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare Plus (HMO D-SNP)
via Zylet 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Select (HMO)
via Zylet 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Savings (HMO)
via Zylet 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Plus (HMO)
via Zylet 		Tier 3 - Preferred Brand — — — None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Zylet 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Vitality Plan (PPO)
via Zylet 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Plan I (PPO)
via Zylet 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Plan II (PPO)
via Zylet 		Tier 4 - Non-Preferred — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 3 hours, 20 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via Zylet 		Non-Preferred — — — None
NC Medicaid Preferred Drug List 2026 Non-Preferred — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 3 hours, 20 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via Zylet 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Zylet 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Zylet 		Not Covered — — — None
Source: CMS QHP JSON  ·  Formulary date: Nov 9, 2026  ·  Checked: 3 hours, 20 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Gold Classic Standard
via Zylet 		Tier 4 - Non-Preferred — — — None
Bronze Classic Standard | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
Silver Classic Standard | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
Gold Classic Standard | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
Bronze Simple Chronic Care CKM | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
Secure | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
Bronze Classic 4700 | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
Silver Classic | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
Silver Simple Diabetes | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
Silver Simple PCP Saver | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
Bronze Simple Diabetes | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
Silver Simple Chronic Care CKM | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010074
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010075
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010111
via Zylet 		Tier 4 - Non-Preferred — — — None
Bronze Elite + PCP Saver Plus
via Zylet 		Tier 4 - Non-Preferred — — — None
Silver Classic
via Zylet 		Tier 4 - Non-Preferred — — — None
Secure
via Zylet 		Tier 4 - Non-Preferred — — — None
Bronze Classic 4700
via Zylet 		Tier 4 - Non-Preferred — — — None
Silver Simple PCP Saver
via Zylet 		Tier 4 - Non-Preferred — — — None
Silver Simple Diabetes
via Zylet 		Tier 4 - Non-Preferred — — — None
Bronze Classic Standard
via Zylet 		Tier 4 - Non-Preferred — — — None
Silver Classic Standard
via Zylet 		Tier 4 - Non-Preferred — — — None
Silver Core Plan | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
Silver Simple Diabetes with Adult Dental & Vision
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010108
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010109
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010110
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010112
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010113
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010114
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010115
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010116
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010117
via Zylet 		Tier 4 - Non-Preferred — — — None
Bronze Simple Diabetes with Adult Dental & Vision | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
Silver Simple Diabetes with Adult Dental & Vision | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision | with Atrium Health
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010076
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010077
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010078
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010079
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010080
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010081
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010082
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010083
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010084
via Zylet 		Tier 4 - Non-Preferred — — — None
69803NC0010085
via Zylet 		Tier 4 - Non-Preferred — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision
via Zylet 		Tier 4 - Non-Preferred — — — None
Bronze Simple Diabetes
via Zylet 		Tier 4 - Non-Preferred — — — None
Silver Core Plan
via Zylet 		Tier 4 - Non-Preferred — — — None
Source: PDF  ·  Formulary date: Oct 20, 2026  ·  Checked: 3 hours, 20 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via Zylet 		Tier 4 - Non-Preferred — — — None
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)
via Zylet 		Tier 4 - Non-Preferred — — — None
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via Zylet 		Tier 4 - Non-Preferred — — — None
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)
via Zylet 		Tier 4 - Non-Preferred — — — None
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)
via Zylet 		Tier 4 - Non-Preferred — — — None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via Zylet 		Tier 4 - Non-Preferred — — — None
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via Zylet 		Tier 4 - Non-Preferred — — — None
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Zylet 		Tier 4 - Non-Preferred — — — None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Zylet 		Tier 4 - Non-Preferred — — — None
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)
via Zylet 		Tier 4 - Non-Preferred — — — None
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Zylet 		Tier 4 - Non-Preferred — — — None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)
via Zylet 		Tier 4 - Non-Preferred — — — None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Zylet 		Tier 4 - Non-Preferred — — — None
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