All *OTIC AGENTS*

Acetasol HC Solution 2-1 % Otic
Acetasol HC Solution 2-1 % Otic

Hydrocortisone-Acetic Acid

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetic Acid Solution 2 % Otic
Acetic Acid Solution 2 % Otic

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetic Acid Solution 2 % Otic
Acetic Acid Solution 2 % Otic

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetic Acid Solution 2 % Otic
Acetic Acid Solution 2 % Otic

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetic Acid Solution 2 % Otic
Acetic Acid Solution 2 % Otic

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetic Acid Solution 2 % Otic
Acetic Acid Solution 2 % Otic

Tier: 1
PA Type: No Prior Authorization
ST: N
Cetraxal SOLUTION 0.2 % OTIC
Cetraxal SOLUTION 0.2 % OTIC

Ciprofloxacin HCl

Tier: 3
PA Type: No Prior Authorization
ST: N
Cipro HC Suspension 0.2-1 % Otic
Cipro HC Suspension 0.2-1 % Otic

Ciprofloxacin-Hydrocortisone

Tier: 3
PA Type: No Prior Authorization
ST: N
Ciprodex Suspension 0.3-0.1 % Otic
Ciprodex Suspension 0.3-0.1 % Otic

Ciprofloxacin-Dexamethasone

Tier: 1
PA Type: No Prior Authorization
ST: N
Ciprodex Suspension 0.3-0.1 % Otic
Ciprodex Suspension 0.3-0.1 % Otic

Ciprofloxacin-Dexamethasone

Tier: 1
PA Type: No Prior Authorization
ST: N
Ciprofloxacin HCl SOLUTION 0.2 % OTIC
Ciprofloxacin HCl SOLUTION 0.2 % OTIC

Tier: 3
PA Type: No Prior Authorization
ST: N
Ciprofloxacin-Dexamethasone Suspension 0.3-0.1 % Otic
Ciprofloxacin-Dexamethasone Suspension 0.3-0.1 % Otic

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N