tretinoin microsphere

Generic: tretinoin microspheres

04% — Gel

Also known as: tretinoin microsphere gel .04%, .08%, .1%

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

7 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 9 hours, 38 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Basic Option 2026	Tier 1 - Generic	✓	—	—	PA
BCBS Federal Standard Option 2026	Tier 1 - Generic	✓	—	—	PA
BCBS Federal Focus 2026	Tier 1 - Generic	✓	—	—	PA
BCBS Federal Standard Option 2026 via Retin-A Micro Pump	Tier 3 - Non-Preferred Brand	✓	—	—	PA
BCBS Federal Basic Option 2026 via Retin-A Micro Pump	Tier 3 - Non-Preferred Brand	✓	—	—	PA
BCBS Federal Basic Option 2026 via Retin-A Micro	Tier 3 - Non-Preferred Brand	✓	—	—	PA
BCBS Federal Standard Option 2026 via Retin-A Micro	Tier 3 - Non-Preferred Brand	✓	—	—	PA

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 9 hours, 38 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via tretinoin microsphere gel / microsphere gel pump	Non-Preferred	—	—	—	None

9 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 9 hours, 38 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - HDHP 2026	Tier 2 - Non-Preferred Generic	✓	—	—	PA
NC State Health Plan - 80/20 Plus PPO 2026	Tier 2 - Non-Preferred Generic	✓	—	—	PA
NC State Health Plan - 70/30 Standard PPO 2026	Tier 2 - Non-Preferred Generic	✓	—	—	PA
NC State Health Plan - HDHP 2026 via Retin-A Micro Pump	Not Covered	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Retin-A Micro Pump	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Retin-A Micro Pump	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026 via Retin-A Micro	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Retin-A Micro	Not Covered	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Retin-A Micro	Not Covered	—	—	—	None

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 9 hours, 38 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via tretinoin microspheres	Tier 3 - Non-Formulary	✓	—	—	PA