TETRACAINE
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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.
Cigna
40 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Connect Bronze CMS Standard
via Altacaine |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze RD 5000 Indiv Med Deductible
via Altacaine |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze 6500 Indiv Med Deductible
via Altacaine |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver 4400 Indiv Med Deductible
via Altacaine |
Tier 2 - Generic | — | — | — | None |
|
Connect myDiabetesCare Bronze
via Altacaine |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver 3000 Indiv Med Deductible
via Altacaine |
Tier 2 - Generic | — | — | — | None |
| Connect Silver RD CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Gold RD CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Silver CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Gold CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Bronze RD CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Bronze CMS Standard | Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD CMS Standard
via Altacaine |
Tier 2 - Generic | — | — | — | None |
|
Connect Gold RD CMS Standard
via Altacaine |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver CMS Standard
via Altacaine |
Tier 2 - Generic | — | — | — | None |
|
Connect Gold CMS Standard
via Altacaine |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze RD CMS Standard
via Altacaine |
Tier 2 - Generic | — | — | — | None |
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Bronze 7000 HSA Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Silver RD 5000 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Silver 3500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Silver RD 2200 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Silver RD 3500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Gold 1500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect myDiabetesCare Silver | Tier 2 - Generic | — | — | — | None |
| Connect Bronze 5500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Bronze 6500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Silver 4400 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect myDiabetesCare Bronze | Tier 2 - Generic | — | — | — | None |
| Connect Silver 3000 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
|
Connect Bronze RD 6000 Indiv Med Deductible
via Altacaine |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via Altacaine |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD 5000 Indiv Med Deductible
via Altacaine |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver 3500 Indiv Med Deductible
via Altacaine |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD 2200 Indiv Med Deductible
via Altacaine |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD 3500 Indiv Med Deductible
via Altacaine |
Tier 2 - Generic | — | — | — | None |
|
Connect Gold 1500 Indiv Med Deductible
via Altacaine |
Tier 2 - Generic | — | — | — | None |
|
Connect myDiabetesCare Silver
via Altacaine |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze 5500 Indiv Med Deductible
via Altacaine |
Tier 2 - Generic | — | — | — | None |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 70/30 Standard PPO 2026
via Altacaine |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Altacaine |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Altacaine |
Tier 3 - Non-Preferred Brand | — | — | — | None |
UnitedHealthcare
13 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UHC Silver Standard (No Referrals)
via Altacaine |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Altacaine |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Altacaine |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Bronze Standard (No Referrals)
via Altacaine |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via Altacaine |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via Altacaine |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Altacaine |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Altacaine |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via Altacaine |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via Altacaine |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via Altacaine |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Bronze Standard+ Dental + Vision (No Referrals)
via Altacaine |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Gold Standard (No Referrals)
via Altacaine |
Tier 1 - Preferred Generic | — | — | — | None |