Xaciato

Generic: clindamycin phosphate

2 % — GEL W/APPL

Coverage by Insurer

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

Ambetter (Centene)

34 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 8 hours, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Complete Gold via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Clear Silver with $0 Insulin Options + Vision + Adult Dental via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Streamlined Silver via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Streamlined Silver with Atrium Health via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Enhanced CHF Heart Care Silver $0 Rx Options via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Signature Silver via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Signature Gold via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Everyday Bronze with Atrium Health via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Elite Bronze with Atrium Health via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Focused Silver with Atrium Health via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Complete Gold with Atrium Health via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Signature Expanded Bronze with Atrium Health via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Signature Silver with Atrium Health via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Signature Gold with Atrium Health via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Complete Gold + Vision + Adult Dental via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Everyday Bronze + Vision + Adult Dental via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Elite Bronze + Vision + Adult Dental via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Everyday Bronze with Atrium Health + Vision + Adult Dental via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Elite Bronze with Atrium Health + Vision + Adult Dental via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Focused Silver with Atrium Health + Vision + Adult Dental via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Complete Gold with Atrium Health + Vision + Adult Dental via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Signature Expanded Bronze + Vision + Adult Dental via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Signature Silver + Vision + Adult Dental via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Signature Gold + Vision + Adult Dental via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Signature Silver with Atrium Health + Vision + Adult Dental via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Signature Gold with Atrium Health + Vision + Adult Dental via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Enhanced Asthma/COPD Care Silver $0 Rx Options via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Everyday Bronze via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Elite Bronze via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Clear Silver with $0 Insulin Options via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST
Signature Expanded Bronze via clindamycin phosphate	Tier 2 - Generic	—	✓	—	ST

Blue Cross Blue Shield of NC

15 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 8 hours, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Advantage 2026 via Twice-Daily	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Advantage 2026 via clindamycin phosphate	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Home with UNC Health Alliance 2026 via clindamycin phosphate	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Local 2026 via clindamycin phosphate	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Care 2026 via clindamycin phosphate	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Value 2026 via clindamycin phosphate	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Home with UNC Health Alliance 2026 via Twice-Daily	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Local 2026 via Twice-Daily	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Care 2026 via Twice-Daily	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Value 2026 via Twice-Daily	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Advantage 2026 via Cleocin-T	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Home with UNC Health Alliance 2026 via Cleocin-T	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Local 2026 via Cleocin-T	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Care 2026 via Cleocin-T	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Value 2026 via Cleocin-T	Tier 2 - Medium Cost Generic/Brand	—	—	—	None

Cigna

20 plans

Source: PDF · Formulary date: Oct 15, 2026 · Checked: 8 hours, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect Gold 1500 Indiv Med Deductible via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze RD CMS Standard via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD CMS Standard via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect Gold RD CMS Standard via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver 5000 Indiv Med Deductible via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver 3600 Indiv Med Deductible via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver 3000 Indiv Med Deductible via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze CMS Standard via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver CMS Standard via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect Gold CMS Standard via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect myDiabetesCare Bronze via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None
Connect myDiabetesCare Silver via clindamycin phosphate	Tier 3 - Preferred Brand	—	—	—	None

NC Medicaid PDL

3 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 8 hours, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Evoclin	Non-Preferred	—	—	—	None
NC Medicaid Preferred Drug List 2026 via clindamycin phosphate	Non-Preferred	—	—	—	None
NC Medicaid Preferred Drug List 2026 via Clindagel	Non-Preferred	—	—	—	None

NC State Health Plan

6 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 8 hours, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 via clindamycin phosphate	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - HDHP 2026 via clindamycin phosphate	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via clindamycin phosphate	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Clindagel	Tier 3 - Non-Preferred Brand	✓	✓	—	PA \| ST
NC State Health Plan - 70/30 Standard PPO 2026 via Clindagel	Tier 3 - Non-Preferred Brand	✓	✓	—	PA \| ST
NC State Health Plan - HDHP 2026 via Clindagel	Tier 3 - Non-Preferred Brand	✓	✓	—	PA \| ST

TRICARE

3 plans

Source: Excel (XLSX) · Formulary date: Sep 23, 2026 · Checked: 8 hours, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via clindamycin phosphate	Tier 1 - Generic Formulary (Basic Core)	—	✓	—	ST Step therapy on 4 of 84 NDCs: CLINDAGEL,CLINDACIN ETZ/PAC,NEUAC,ONEXTON, WO 3 DIFF GEN ACNE DRUGS IN LAST 180D REQ PA
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	—	—	✓ QPDE - XACIATO GEL TO BE DISP AT A MAX QTY OF 8 GRAMS(1 CARTON) PER DISP AT RETAIL OR MAIL	QL Quantity limit
TRICARE Uniform Formulary 2026 via Clindagel	Tier 3 - Non-Formulary	—	✓	—	ST Step therapy: CLINDAGEL,CLINDACIN ETZ/PAC,NEUAC,ONEXTON, WO 3 DIFF GEN ACNE DRUGS IN LAST 180D REQ PA