Xerac Ac

Generic: aluminum chloride

6.25% — Solution

12%

Also known as: XERAC AC SOLN 6.25% aluminum chloride
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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: 11 hours, 48 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via Drysol 		Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Drysol 		Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - HDHP 2026
via Drysol 		Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - HDHP 2026 Tier 3 - Non-Preferred Brand — — — None
Source: CMS QHP JSON  ·  Checked: 11 hours, 48 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Bronze Elite + PCP Saver Plus Tier 3 - Preferred Brand — — — None
Silver Classic Tier 3 - Preferred Brand — — — None
Secure Tier 3 - Preferred Brand — — — None
Bronze Classic 4700 Tier 3 - Preferred Brand — — — None
Silver Simple PCP Saver Tier 3 - Preferred Brand — — — None
Gold Elite Saver Plus Tier 3 - Preferred Brand — — — None
Silver Simple Diabetes Tier 3 - Preferred Brand — — — None
Secure | with Atrium Health Tier 3 - Preferred Brand — — — None
Bronze Classic 4700 | with Atrium Health Tier 3 - Preferred Brand — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health Tier 3 - Preferred Brand — — — None
Silver Classic | with Atrium Health Tier 3 - Preferred Brand — — — None
Silver Simple Diabetes | with Atrium Health Tier 3 - Preferred Brand — — — None
Silver Simple PCP Saver | with Atrium Health Tier 3 - Preferred Brand — — — None
Gold Elite Saver Plus | with Atrium Health Tier 3 - Preferred Brand — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 3 - Preferred Brand — — — None
Bronze Simple Chronic Care CKM | with Atrium Health Tier 3 - Preferred Brand — — — None
Bronze Simple Diabetes | with Atrium Health Tier 3 - Preferred Brand — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 3 - Preferred Brand — — — None
Silver Simple Chronic Care CKM | with Atrium Health Tier 3 - Preferred Brand — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 3 - Preferred Brand — — — None
AIAN Cost Share Tier 3 - Preferred Brand — — — None
AIAN Cost Share | with Atrium Health Tier 3 - Preferred Brand — — — None
Bronze Classic Standard
via Drysol 		Tier 3 - Preferred Brand — — — None
Silver Classic Standard
via Drysol 		Tier 3 - Preferred Brand — — — None
Gold Classic Standard
via Drysol 		Tier 3 - Preferred Brand — — — None
Bronze Classic Standard | with Atrium Health
via Drysol 		Tier 3 - Preferred Brand — — — None
Silver Classic Standard | with Atrium Health
via Drysol 		Tier 3 - Preferred Brand — — — None
Gold Classic Standard | with Atrium Health
via Drysol 		Tier 3 - Preferred Brand — — — None
Bronze Elite + PCP Saver Plus
via Drysol 		Tier 3 - Preferred Brand — — — None
Silver Classic
via Drysol 		Tier 3 - Preferred Brand — — — None
Secure
via Drysol 		Tier 3 - Preferred Brand — — — None
Bronze Classic 4700
via Drysol 		Tier 3 - Preferred Brand — — — None
Silver Simple PCP Saver
via Drysol 		Tier 3 - Preferred Brand — — — None
Gold Elite Saver Plus
via Drysol 		Tier 3 - Preferred Brand — — — None
Silver Simple Diabetes
via Drysol 		Tier 3 - Preferred Brand — — — None
Secure | with Atrium Health
via Drysol 		Tier 3 - Preferred Brand — — — None
Bronze Classic 4700 | with Atrium Health
via Drysol 		Tier 3 - Preferred Brand — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health
via Drysol 		Tier 3 - Preferred Brand — — — None
Silver Classic | with Atrium Health
via Drysol 		Tier 3 - Preferred Brand — — — None
Silver Simple Diabetes | with Atrium Health
via Drysol 		Tier 3 - Preferred Brand — — — None
Silver Simple PCP Saver | with Atrium Health
via Drysol 		Tier 3 - Preferred Brand — — — None
Gold Elite Saver Plus | with Atrium Health
via Drysol 		Tier 3 - Preferred Brand — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Drysol 		Tier 3 - Preferred Brand — — — None
Bronze Simple Chronic Care CKM | with Atrium Health
via Drysol 		Tier 3 - Preferred Brand — — — None
Bronze Simple Diabetes | with Atrium Health
via Drysol 		Tier 3 - Preferred Brand — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Drysol 		Tier 3 - Preferred Brand — — — None
Silver Simple Chronic Care CKM | with Atrium Health
via Drysol 		Tier 3 - Preferred Brand — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Drysol 		Tier 3 - Preferred Brand — — — None
Bronze Classic Standard Tier 3 - Preferred Brand — — — None
AIAN Cost Share | with Atrium Health
via Drysol 		Tier 3 - Preferred Brand — — — None
AIAN Cost Share
via Drysol 		Tier 3 - Preferred Brand — — — None
Silver Classic Standard Tier 3 - Preferred Brand — — — None
Gold Classic Standard Tier 3 - Preferred Brand — — — None
Bronze Classic Standard | with Atrium Health Tier 3 - Preferred Brand — — — None
Silver Classic Standard | with Atrium Health Tier 3 - Preferred Brand — — — None
Gold Classic Standard | with Atrium Health Tier 3 - Preferred Brand — — — None
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