neomycin sulfate/polymyxin B sulfate/gramicidin D

1.75 mg-10,000 unit-0.025 mg/mL — Drops

Also known as: NEOMYCIN-POLYMYXIN-GRAMICIDIN

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

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 3 hours, 36 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via neomycin-polymyxin-gramicidin	Non-Preferred	—	—	—	None

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 3 hours, 36 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 1 - Basic Core Formulary	—	—	—	None

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 3 hours, 36 minutes ago

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