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Suspension

Aminoglycosides

Also known as: Tobradex
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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: Apr 1, 2026  ·  Checked: 20 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026
via Tobradex 		Tier 2 - Preferred Brand — — — None
BCBS Federal Focus 2026
via Tobradex 		Tier 2 - Preferred Brand — — — None
BCBS Federal Basic Option 2026
via Tobradex 		Tier 2 - Preferred Brand — — — None
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 20 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Tobradex 		Tier 1 - Preferred Generic — — — None
Longevity Health Plan (HMO I-SNP)
via Tobradex 		Tier 1 - Preferred Generic — — ✓ 3.5 per 14 days QL
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Tobradex 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Tobradex 		Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Tobradex 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Tobradex 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Tobradex 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Tobradex 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Tobradex 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Tobradex 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Tobradex 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Tobradex 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Tobradex 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Tobradex 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Tobradex 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Signature (HMO-POS)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Guardian (HMO-POS I-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Freedom (HMO-POS)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Liberty (HMO-POS)
via Tobradex 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Champion (HMO-POS C-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature (HMO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Dual (HMO D-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature (HMO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Value Plus (HMO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Prime (HMO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature Care (HMO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Full Dual Care (HMO D-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Enhanced (HMO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Enhanced (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Enhanced (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature Extra (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature Giveback (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Chronic Care (HMO C-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL 009 NC (HMO D-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED CORE 001 NC (HMO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 002 NC (HMO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 012 NC (HMO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 001 NC (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 003 NC (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 005 NC (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 008 NC (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Wellcare Giveback Open (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S001 (PPO D-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S2 (PPO D-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Wellcare Simple Open (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Wellcare Simple (HMO-POS)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Wellcare Dual Liberty Open (PPO D-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Wellcare Assist Open (PPO)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Wellcare Dual Access (HMO-POS D-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Wellcare Dual Liberty (HMO-POS D-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Wellcare Dual Reserve (HMO-POS D-SNP)
via Tobradex 		Tier 3 - Preferred Brand — — — None
Blue Medicare Essential Plus (HMO-POS)
via Tobradex 		Tier 4 - Non-Preferred — — — None
Blue Medicare Choice (HMO)
via Tobradex 		Tier 4 - Non-Preferred — — — None
Blue Medicare Essential (HMO)
via Tobradex 		Tier 4 - Non-Preferred — — — None
Experience Health Medicare Advantage (HMO)
via Tobradex 		Tier 4 - Non-Preferred — — — None
Healthy Blue + Medicare (HMO-POS D-SNP)
via Tobradex 		Tier 4 - Non-Preferred — — — None
Alignment Health Platinum (HMO)
via Tobradex 		Tier 4 - Non-Preferred — — — None
Alignment Health NC Duals (HMO-POS D-SNP)
via Tobradex 		Tier 4 - Non-Preferred — — — None
Alignment Health smartHMO (HMO)
via Tobradex 		Tier 4 - Non-Preferred — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Tobradex 		Tier 4 - Non-Preferred — — — None
Alignment Health Platinum Select (HMO)
via Tobradex 		Tier 4 - Non-Preferred — — — None
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Tobradex 		Tier 4 - Non-Preferred — — — None
Alignment Health AVA (PPO)
via Tobradex 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Plan I (PPO)
via Tobradex 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Plan II (PPO)
via Tobradex 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Vitality Plan (PPO)
via Tobradex 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Tobradex 		Tier 4 - Non-Preferred — — — None
Blue Medicare PPO Enhanced (PPO)
via Tobradex 		Tier 4 - Non-Preferred — — — None
Blue Medicare Enhanced (HMO-POS)
via Tobradex 		Tier 4 - Non-Preferred — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 20 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via Tobradex 		Preferred — — — None
NC Medicaid Preferred Drug List 2026 Preferred — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 20 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via Tobradex 		Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Tobradex 		Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Tobradex 		Tier 2 - Non-Preferred Generic — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 20 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UnitedHealthcare NC Individual & Family 2026 Tier 3 - Mid-Range Cost — — — None
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