| Drug | Covered | Cash |
|---|---|---|
| Naftin 2% Gel | $20 | - |
| Noritate 1% Cream | $25 | - |
| Onexton | $25 | $65 |
| Opzelura | $0 | $35 |
| Oracea 40mg | $0 | - |
| Ovace | $25 | - |
| Oxistat Lotion | $25 | - |
| Pramosone | $10 | - |
| Qbrexza | $0 | - |
| Retin A Micro Pump .06%,.08% | $25 | $65 |
| Rhofade Cream | $0 | - |
| Seysara | $35 | $175 |
| Sitavig | $0 | - |
| Soolantra | $20 | - |
| Sorilux Foam 60g | $0 | - |
| Targadox 50mg Tabs | $7 | $7 |
| Tazorac | $35 | $125 |
| Tri-Luma | $20 | $90 |
| Twyneo | $20 | $75 |
| Vectical | $0 | - |
| Veregen | $25 | - |
| Vtama | $0 | $35 |
| Winlevi 1% Cream | $20 | $200 |
| Xerese Cream 5%,1% | $25 | $75 |
| Zilxi | $25 | - |
| Zoryve | $0 | $75 |