tretinoin microsphere gel / microsphere gel pump

Generic: tretinoin microsphere

04% — Gel

Acne Agents

Also known as: Retin-A Micro tretinoin microsphere gel .04%, .08%, .1%

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: Oct 1, 2026  ·  Checked: 18 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026
via tretinoin microsphere
Tier 1 - Generic ✓ — — PA
BCBS Federal Basic Option 2026
via tretinoin microsphere
Tier 1 - Generic ✓ — — PA
BCBS Federal Standard Option 2026
via tretinoin microsphere
Tier 1 - Generic ✓ — — 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
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 18 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Non-Preferred — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 18 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via tretinoin microsphere
Tier 1 - Preferred Generic ✓ — — PA
NC State Health Plan - 70/30 Standard PPO 2026
via tretinoin microsphere
Tier 1 - Preferred Generic ✓ — — PA
NC State Health Plan - HDHP 2026
via tretinoin microsphere
Tier 1 - Preferred Generic ✓ — — PA
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
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