minocycline hcl

1.5 %, 105 mg, 115 mg, 135 mg, 4 %, 40 mg, 45 mg, 55 mg, 65 mg, 80 mg, 90 mg — Capsule

ANTIMYCOBACTERIAL AGENTS

Also known as: minocycline hcl oral capsule minocycline hcl cap 50 mg minocycline hcl cap 75 mg, 100 mg minocycline hcl tb24 45mg, 55mg, 65mg, 80mg, 90mg, 105mg, 115mg, 135mg minocycline hcl caps 50mg, 75mg, 100mg; tabs 50mg, 75mg, 100mg minocycline hcl caps 50mg, 75mg, 100mg; tabs 50mg, 75mg, 100mg; tb24 45mg, 55mg, 65mg, 80mg, 90mg, 105mg, 115mg, 135mg MINOCYCLINE ER AMZEEQ ZILXI SOLODYN XIMINO EMROSI MINOCYCLINE HCL ER minocycline hcl caps 50mg, 75mg, 100mg; minocycline hcl tb24 minocycline hcl tb24 45mg, 55mg, 65mg, Minocycline HCl Oral Capsule Minocycline HCl Oral Tablet
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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  ·  Checked: 15 hours, 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Gold Signature + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Premier + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Essential + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Signature + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Signature + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Essential + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Gold Premier + No Referrals Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 15 hours, 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026 Tier 1 - Generic — — — None
BCBS Federal Focus 2026 Tier 1 - Generic — — — None
BCBS Federal Standard Option 2026 Tier 1 - Generic — — — None
BCBS Federal Standard Option 2026
via Zilxi 		Tier 3 - Non-Preferred Brand — — ✓ QL
BCBS Federal Basic Option 2026
via Zilxi 		Tier 3 - Non-Preferred Brand — — ✓ QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 15 hours, 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Advantage 2026 Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Value 2026 Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Care 2026 Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Local 2026 Tier 2 - Medium Cost Generic/Brand — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 15 hours, 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze 6500 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect myDiabetesCare Silver Tier 1 - Preferred Generic — — — None
Connect Silver RD 2200 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect Gold 1500 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect myDiabetesCare Bronze Tier 1 - Preferred Generic — — — None
Connect Bronze 5500 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect Bronze RD 6000 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect Silver 3500 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect Bronze RD 5000 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect Silver RD 3500 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect Bronze 7000 HSA Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect Silver 4400 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect Silver RD 5000 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect Silver 3000 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect Bronze RD CMS Standard Tier 2 - Generic — — — None
Connect Bronze CMS Standard Tier 2 - Generic — — — None
Connect Gold RD CMS Standard Tier 2 - Generic — — — None
Connect Silver CMS Standard Tier 2 - Generic — — — None
Connect Silver RD CMS Standard Tier 2 - Generic — — — None
Connect Gold CMS Standard Tier 2 - Generic — — — None
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 15 hours, 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Troy Medicare (HMO) Tier 2 - Generic — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 2 - Generic — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 2 - Generic — — — None
Alignment Health AVA (PPO) Tier 3 - Preferred Brand — — — None
Alignment Health smartHMO (HMO) Tier 3 - Preferred Brand — — — None
Alignment Health NC Duals (HMO-POS D-SNP) Tier 3 - Preferred Brand — — — None
Alignment Health Platinum (HMO) Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare (HMO D-SNP) Tier 3 - Preferred Brand — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 3 - Preferred Brand — — — None
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare Plus (HMO D-SNP) Tier 3 - Preferred Brand — — — None
Alignment Health Platinum Select (HMO) Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Select (HMO) Tier 4 - Non-Preferred — — — None
HealthSpring Preferred Savings (HMO) Tier 4 - Non-Preferred — — — None
HealthSpring Preferred Plus (HMO) Tier 4 - Non-Preferred — — — None
Wellcare Simple Open (PPO) Tier 4 - Non-Preferred — — — None
Wellcare Simple (HMO-POS) Tier 4 - Non-Preferred — — — None
Wellcare Giveback Open (PPO) Tier 4 - Non-Preferred — — — None
Blue Medicare PPO Enhanced (PPO) Tier 4 - Non-Preferred — — — None
Blue Medicare Essential Plus (HMO-POS) Tier 4 - Non-Preferred — — — None
Blue Medicare Enhanced (HMO-POS) Tier 4 - Non-Preferred — — — None
Blue Medicare Choice (HMO) Tier 4 - Non-Preferred — — — None
Blue Medicare Essential (HMO) Tier 4 - Non-Preferred — — — None
Experience Health Medicare Advantage (HMO) Tier 4 - Non-Preferred — — — None
Wellcare Dual Liberty Open (PPO D-SNP) Tier 4 - Non-Preferred — — — None
Wellcare Assist Open (PPO) Tier 4 - Non-Preferred — — — None
Wellcare Dual Access (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0001 (PPO) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0004 (PPO) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0016 (PPO) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0017 (PPO) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0019 (PPO) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-D001 (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-S3 (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-24 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 4 - Non-Preferred — — — None
Erickson Advantage Signature (HMO-POS) Tier 4 - Non-Preferred — — — None
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 4 - Non-Preferred — — — None
Erickson Advantage Freedom (HMO-POS) Tier 4 - Non-Preferred — — — None
Erickson Advantage Liberty (HMO-POS) Tier 4 - Non-Preferred — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 4 - Non-Preferred — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 4 - Non-Preferred — — — None
UHC Complete Care NC-28 (HMO-POS C-SNP) Tier 4 - Non-Preferred — — — None
Erickson Advantage Champion (HMO-POS C-SNP) Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (HMO) Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Dual (HMO D-SNP) Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Signature (HMO) Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Value Plus (HMO) Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Prime (HMO) Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Signature Care (HMO) Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Enhanced (HMO) Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Signature Extra (PPO) Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Signature Giveback (PPO) Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Chronic Care (HMO C-SNP) Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 4 - Non-Preferred — ✓ — ST
HealthSpring True Choice (PPO) Tier 4 - Non-Preferred — — — None
HealthSpring Preferred (HMO) Tier 4 - Non-Preferred — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 15 hours, 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026 Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Not Covered — — — None
Source: Excel (XLSX)  ·  Formulary date: Jun 24, 2026  ·  Checked: 15 hours, 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 3 - Non-Formulary ✓ — — PA
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