Retin-A Micro Pump

Generic: tretinoin microspheres

04% — Gel

ACNE PRODUCTS

Also known as: RETIN-A MICRO PUMP GEL .04%, .08%, .1% RETIN-A MICRO PUMP GEL .08%

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 14 hours ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026
via tretinoin microsphere
Tier 1 - Generic PA
BCBS Federal Basic Option 2026
via tretinoin microsphere
Tier 1 - Generic PA
BCBS Federal Focus 2026
via tretinoin microsphere
Tier 1 - Generic PA
BCBS Federal Basic Option 2026 Tier 3 - Non-Preferred Brand PA
BCBS Federal Standard Option 2026 Tier 3 - Non-Preferred Brand PA
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 14 hours ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via tretinoin microsphere
Tier 2 - Non-Preferred Generic PA
NC State Health Plan - 80/20 Plus PPO 2026
via tretinoin microsphere
Tier 2 - Non-Preferred Generic PA
NC State Health Plan - 70/30 Standard PPO 2026
via tretinoin microsphere
Tier 2 - Non-Preferred Generic PA
NC State Health Plan - 80/20 Plus PPO 2026 Not Covered None
NC State Health Plan - 70/30 Standard PPO 2026 Not Covered None
NC State Health Plan - HDHP 2026 Not Covered None
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 14 hours ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via tretinoin microspheres
Tier 3 - Non-Formulary PA
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