tetracaine hcl ophth

Solution

MOUTH/THROAT/DENTAL AGENTS

Also known as: tetracaine hcl ophth soln 0.5%
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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: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 15 hours, 30 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026 Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Value 2026 Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Care 2026 Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Local 2026 Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Tetracaine Hcl 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Value 2026
via Tetracaine Hcl 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Care 2026
via Tetracaine Hcl 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Local 2026
via Tetracaine Hcl 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Advantage 2026
via Tetracaine Hcl 		Tier 4 - Higher Cost Brand — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 15 hours, 30 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via Tetracaine Hydrochloride 		Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Tetracaine Hcl 		Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Tetracaine Hcl 		Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - HDHP 2026
via Tetracaine Hcl 		Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Tetracaine Hydrochloride 		Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Tetracaine Hydrochloride 		Tier 3 - Non-Preferred Brand — — — None
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 15 hours, 30 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Bronze Standard (No Referrals)
via Tetracaine Hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Silver Standard (No Referrals)
via Tetracaine Hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Gold Standard (No Referrals)
via Tetracaine Hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Tetracaine Hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Tetracaine Hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via Tetracaine Hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via Tetracaine Hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Tetracaine Hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Tetracaine Hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via Tetracaine Hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Bronze Standard+ Dental + Vision (No Referrals)
via Tetracaine Hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via Tetracaine Hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via Tetracaine Hydrochloride 		Tier 1 - Preferred Generic — — — None
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