Ovace

Generic: sodium sulfacetamide , wash

10 % — CLEANSER (ML)

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

1 plan

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 7 hours, 4 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via sodium sulfacetamide shampoo, wash	Non-Preferred	—	—	—	None

1 plan

Source: Excel (XLSX) · Formulary date: Sep 23, 2026 · Checked: 7 hours, 4 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 2 - Brand Formulary	✓	—	—	PA PA: 1270/48001/90693 PA DRUGS, DOD PA REQUIRED