Solodyn

Generic: minocycline hcl

105 MG, 115MG, 55 MG, 65 MG, 80 MG — TABLET, EXTENDED RELEASE 24 HR

Tetracycline-class Drug

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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: Sep 22, 2026  ·  Checked: 7 hours, 11 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via minocycline hcl 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via minocycline hcl 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Premier + No Referrals
via minocycline hcl 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via minocycline hcl 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via minocycline hcl 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via minocycline hcl 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via minocycline hcl 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via minocycline hcl 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via minocycline hcl 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via minocycline hcl 		Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 7 hours, 11 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026
via minocycline hcl 		Tier 1 - Generic — — — None
BCBS Federal Basic Option 2026
via minocycline hcl 		Tier 1 - Generic — — — None
BCBS Federal Standard Option 2026
via minocycline hcl 		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: Oct 1, 2026  ·  Checked: 7 hours, 11 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026
via minocycline hcl 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via minocycline hcl 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Local 2026
via minocycline hcl 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Value 2026
via minocycline hcl 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Care 2026
via minocycline hcl 		Tier 2 - Medium Cost Generic/Brand — — — None
Source: PDF  ·  Formulary date: Oct 15, 2026  ·  Checked: 7 hours, 11 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze 5500 Indiv Med Deductible
via minocycline hcl 		Tier 1 - Preferred Generic — — — None
Connect Bronze 6500 Indiv Med Deductible
via minocycline hcl 		Tier 1 - Preferred Generic — — — None
Connect Silver 5000 Indiv Med Deductible
via minocycline hcl 		Tier 1 - Preferred Generic — — — None
Connect Silver 3600 Indiv Med Deductible
via minocycline hcl 		Tier 1 - Preferred Generic — — — None
Connect Silver 3000 Indiv Med Deductible
via minocycline hcl 		Tier 1 - Preferred Generic — — — None
Connect myDiabetesCare Bronze
via minocycline hcl 		Tier 1 - Preferred Generic — — — None
Connect myDiabetesCare Silver
via minocycline hcl 		Tier 1 - Preferred Generic — — — None
Connect Gold 1500 Indiv Med Deductible
via minocycline hcl 		Tier 1 - Preferred Generic — — — None
Connect Bronze RD 5000 Indiv Med Deductible
via minocycline hcl 		Tier 1 - Preferred Generic — — — None
Connect Bronze RD 6000 Indiv Med Deductible
via minocycline hcl 		Tier 1 - Preferred Generic — — — None
Connect Silver RD 3500 Indiv Med Deductible
via minocycline hcl 		Tier 1 - Preferred Generic — — — None
Connect Silver RD 5000 Indiv Med Deductible
via minocycline hcl 		Tier 1 - Preferred Generic — — — None
Connect Silver RD 2200 Indiv Med Deductible
via minocycline hcl 		Tier 1 - Preferred Generic — — — None
Connect Bronze 7000 HSA Indiv Med Deductible
via minocycline hcl 		Tier 1 - Preferred Generic — — — None
Connect Bronze CMS Standard
via minocycline hcl 		Tier 2 - Generic — — — None
Connect Gold CMS Standard
via minocycline hcl 		Tier 2 - Generic — — — None
Connect Silver CMS Standard
via minocycline hcl 		Tier 2 - Generic — — — None
Connect Silver RD CMS Standard
via minocycline hcl 		Tier 2 - Generic — — — None
Connect Bronze RD CMS Standard
via minocycline hcl 		Tier 2 - Generic — — — None
Connect Gold RD CMS Standard
via minocycline hcl 		Tier 2 - Generic — — — None
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 7 hours, 11 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Longevity Health Plan (HMO I-SNP)
via minocycline hcl 		Tier 1 - Preferred Generic — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via minocycline hcl 		Tier 2 - Generic — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP)
via minocycline hcl 		Tier 2 - Generic — — — None
Troy Medicare (HMO)
via minocycline hcl 		Tier 2 - Generic — — — None
Alignment Health NC Duals (HMO-POS D-SNP)
via minocycline hcl 		Tier 3 - Preferred Brand — — — None
Alignment Health AVA (PPO)
via minocycline hcl 		Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare Plus (HMO D-SNP)
via minocycline hcl 		Tier 3 - Preferred Brand — — — None
Alignment Health Platinum (HMO)
via minocycline hcl 		Tier 3 - Preferred Brand — — — None
Alignment Health smartHMO (HMO)
via minocycline hcl 		Tier 3 - Preferred Brand — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via minocycline hcl 		Tier 3 - Preferred Brand — — — None
Alignment Health Platinum Select (HMO)
via minocycline hcl 		Tier 3 - Preferred Brand — — — None
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via minocycline hcl 		Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare (HMO D-SNP)
via minocycline hcl 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Enhanced (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Signature Extra (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Signature (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Signature (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Signature Giveback (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Signature (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
Erickson Advantage Signature (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Erickson Advantage Guardian (HMO-POS I-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Erickson Advantage Champion (HMO-POS C-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Erickson Advantage Freedom (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Erickson Advantage Liberty (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
HealthSpring True Choice (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Healthy Blue + Medicare (HMO-POS D-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
HealthSpring Preferred (HMO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
HealthSpring Preferred Select (HMO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
HealthSpring Preferred Savings (HMO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
HealthSpring Preferred Plus (HMO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Enhanced (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-S001 (PPO D-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-S2 (PPO D-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Wellcare Simple Open (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Wellcare Dual Liberty Open (PPO D-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Wellcare Assist Open (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Wellcare Giveback Open (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0001 (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0004 (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0016 (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0017 (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0019 (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (HMO)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Dual (HMO D-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Signature (HMO)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Value Plus (HMO)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Prime (HMO)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Signature Care (HMO)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Full Dual Care (HMO D-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Chronic Care (HMO C-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Enhanced (HMO)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
Aetna Medicare Chronic Care Value (HMO C-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
Blue Medicare PPO Enhanced (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Blue Medicare Essential Plus (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Blue Medicare Enhanced (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Blue Medicare Choice (HMO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Blue Medicare Essential (HMO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Experience Health Medicare Advantage (HMO)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Wellcare Simple (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Wellcare Dual Access (HMO-POS D-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Wellcare Dual Reserve (HMO-POS D-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Wellcare Dual Liberty (HMO-POS D-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
UHC Complete Care NC-28 (HMO-POS C-SNP)
via minocycline hcl 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (PPO)
via minocycline hcl 		Tier 4 - Non-Preferred — ✓ — ST
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 7 hours, 11 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via minocycline hcl 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via minocycline hcl 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via minocycline hcl 		Not Covered — — — None
Source: Excel (XLSX)  ·  Formulary date: Sep 23, 2026  ·  Checked: 7 hours, 11 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via minocycline hcl 		Tier 1 - Generic Formulary ✓ ✓ — PA | ST PA on 26 of 132 NDCs: 1270/48001/90693 PA DRUGS, DOD PA REQUIRED; Step therapy on 17 of 132 NDCs: SEL ORAL TETRACYCLINES FOR PT >=13Y/O W/O SEL GEN DOXYCYCLINE AND SEL GEN MINOCYCLINE IN 180D REQPA
TRICARE Uniform Formulary 2026
via Ximino 		Tier 3 - Non-Formulary — ✓ — ST Step therapy: SEL ORAL TETRACYCLINES FOR PT >=13Y/O W/O SEL GEN DOXYCYCLINE AND SEL GEN MINOCYCLINE IN 180D REQPA
TRICARE Uniform Formulary 2026 Tier 3 - Non-Formulary ✓ — — PA PA: 1270/48001/90693 PA DRUGS, DOD PA REQUIRED
TRICARE Uniform Formulary 2026
via minocycline hcl er 		Tier 3 - Non-Formulary — ✓ — ST Step therapy: SEL ORAL TETRACYCLINES FOR PT >=13Y/O W/O SEL GEN DOXYCYCLINE AND SEL GEN MINOCYCLINE IN 180D REQPA
TRICARE Uniform Formulary 2026
via Zilxi 		Tier 3 - Non-Formulary — ✓ — ST Step therapy: MIRVASO,SOOLANTRA,ZILXI 1.5% FOAM,TOPICAL RHOFADE W/O USE OF GEN TOPICAL METRONIDAZOLE IN 180D REQPA
TRICARE Uniform Formulary 2026
via Emrosi 		Tier 3 - Non-Formulary ✓ — — PA PA: 1270/48001/90693 PA DRUGS, DOD PA REQUIRED
TRICARE Uniform Formulary 2026
via Minocycline Er 		Tier 3 - Non-Formulary — ✓ — ST Step therapy: SEL ORAL TETRACYCLINES FOR PT >=13Y/O W/O SEL GEN DOXYCYCLINE AND SEL GEN MINOCYCLINE IN 180D REQPA
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