Zilxi

Generic: minocycline hcl

1.5% — Foam

ROSACEA AGENTS

Also known as: ZILXI FOAM 1.5%

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: 12 hours, 49 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026
via minocycline hcl
Tier 1 - Generic None
BCBS Federal Basic Option 2026
via minocycline hcl
Tier 1 - Generic None
BCBS Federal Standard Option 2026
via minocycline hcl
Tier 1 - Generic None
BCBS Federal Standard Option 2026 Tier 3 - Non-Preferred Brand QL
BCBS Federal Basic Option 2026 Tier 3 - Non-Preferred Brand QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 12 hours, 49 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026
via minocycline hcl
Tier 2 - Medium Cost Generic/Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via minocycline hcl
Tier 2 - Medium Cost Generic/Brand None
BCBSNC Blue Local 2026
via minocycline hcl
Tier 2 - Medium Cost Generic/Brand None
BCBSNC Blue Care 2026
via minocycline hcl
Tier 2 - Medium Cost Generic/Brand None
BCBSNC Blue Value 2026
via minocycline hcl
Tier 2 - Medium Cost Generic/Brand None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 12 hours, 49 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via minocycline hcl
Not Covered None
NC State Health Plan - 70/30 Standard PPO 2026
via minocycline hcl
Not Covered None
NC State Health Plan - HDHP 2026
via minocycline hcl
Not Covered None
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 12 hours, 49 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via minocycline hcl
Tier 3 - Non-Formulary PA
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 12 hours, 49 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UnitedHealthcare NC Individual & Family 2026
via minocycline hcl
Tier 2 - Lower Cost None
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