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You searched for Lidocaine Hcl Injection Syringe.

Lidocaine Hcl At a Glance
Covered:	No
Your Cost*:	$$$$
Notices?:	No
* Your cost reflects copayment amount for drug. Individuals with high deductible plans may pay full cost of drug until deductible is met.

Strength:

lidocaine HCl 30 mg/3 mL (1%) injection syringe

Lidocaine Hcl is not included in this formulary. Member pays full cost.

Drug Name	Drug Form	Covered	Type	Your Cost*	Notices?
Bupivacaine-Dextrose-Water(PF)	Bupivacaine In Dextrose And Water (PF) Injection Solution	Yes	Generic	$$$$	No
Bupivacaine-Epinephrine (PF)	Bupivacaine-Epinephrine (PF) Injection Solution	Yes	Generic	$$$$	No
Chloroprocaine (PF)	Chloroprocaine (PF) Injection Solution	Yes	Generic	$$$$	No
Sensorcaine	Sensorcaine Injection Solution	Yes	Brand	$$$$	No
Sensorcaine-MPF/Epinephrine	Sensorcaine-MPF/Epinephrine Injection Solution	Yes	Brand	$$$$	No
Lidocaine Viscous	Lidocaine Viscous Mucosal Solution	Yes	Generic	$$$$	Yes
Lidocaine Hcl	Lidocaine Hcl Mucosal Jelly	Yes	Generic	$$$$	Yes
Pontocaine (PF)	Pontocaine (PF) Solution For Injection	Yes	Brand	$$$$	No
Xylocaine	Xylocaine Mucosal Solution	Yes	Brand	$$$$	Yes

Drug Name	Drug Form	Covered	Type	Your Cost*	Notices?
Accucaine Kit	Accucaine Kit Injection, Topical	No	Brand	$$$$	No
Articadent Dental	Articadent Dental Injection Cartridge	No	Brand	$$$$	No
Bucalsep	Bucalsep Mucosal Solution	No	Brand	$$$$	No
Bucalsep	Bucalsep Mucosal Spray	No	Brand	$$$$	No
Buffered Lidocaine	Buffered Lidocaine Injection Syringe	No	Brand	$$$$	No
Bupivacaine-Lidocaine-Sod Chlr	Bupivacaine-Lidocaine In Nacl,Iso-Osmotic Injection Syringe	No	Generic	$$$$	No
Bupiv-Dexamet-Epi In Sod Chlor	Bupivacaine-Dexameth-Epineph In Sod Chlor Injection Syringe	No	Generic	$$$$	No
Bupivacaine In Nacl(PF)	Bupivacaine (PF) In 0.9% Nacl Infilt,Hi Var Rate Elast Pump	No	Generic	$$$$	No
Bupivacaine In Nacl(PF)	Bupivacaine (PF) In 0.9% Nacl Injection Pump Reservoir	No	Generic	$$$$	No
Bupivacaine In Nacl(PF)	Bupivacaine (PF) In 0.9 % Sod Chlor Epidural Pump Reservoir	No	Generic	$$$$	No
Bupivacaine (PF)	Bupivacaine (PF) Infiltrat,Fix Rate Elast Pump	No	Generic	$$$$	No
Bupivacaine In Nacl(PF)	Bupivacaine (PF) In 0.9% Nacl Infiltrat,Fix Rate Elast Pump	No	Generic	$$$$	No
Bupivacaine (PF)	Bupivacaine (PF) Local Infilt,Hi Var Rate Elast Pump	No	Generic	$$$$	No
Bupivacaine (PF)	Bupivacaine (PF) Local Infl.Lo Var Rate,Pca,Elas Pmp	No	Generic	$$$$	No
Bupivacaine In Nacl(PF)	Bupivacaine (PF) In 0.9% Nacl Injection Solution	No	Generic	$$$$	No
Bupivacaine In Nacl(PF)	Bupivacaine (PF) In 0.9% Nacl Injection Syringe	No	Generic	$$$$	No
Bupivacaine-Epinephrine Bitart	Bupivacaine-Epinephrine Bitartrate Injection Cartridge	No	Generic	$$$$	No
Bupivacaine-Dexameth In Water	Bupivacaine-Dexamethasone In Sterile Water Injection Syringe	No	Generic	$$$$	No
Bupivacaine-Ketorolac-Ketamine	Bupivacaine-Ketorolac-Ketamine Injection Syringe	No	Generic	$$$$	No
Bupivacaine Hcl	Bupivacaine Hcl Injection Solution	No	Generic	$$$$	No
Carbocaine	Carbocaine Injection Solution	No	Brand	$$$$	No
Citanest Forte Dental	Citanest Forte Dental Injection Cartridge	No	Brand	$$$$	No
Citanest Plain Dental	Citanest Plain Dental Injection Cartridge	No	Brand	$$$$	No
Clorotekal (PF)	Clorotekal (PF) Intrathecal Solution	No	Brand	$$$$	No
D-Care 100X (PF)	D-Care 100X (PF) Injection Kit	No	Brand	$$$$	No
Glydo	Glydo Mucosal Jelly In Applicator	No	Brand	$$$$	No
IV Infusion CPI	IV Infusion CPI Kit	No	Brand	$$$$	No
Lidocaine (PF)	Lidocaine (PF) Injection Syringe	No	Generic	$$$$	No
Lidocaine (PF)	Lidocaine (PF) Epidural Syringe	No	Generic	$$$$	No
Lidocaine (PF) In D7.5W	Lidocaine (PF) In Dextrose 7.5 % Intrathecal Solution	No	Generic	$$$$	No
Lidocaine With Sod Phosphate	Lidocaine Buffered With Sodium Phosphate Injection Syringe	No	Generic	$$$$	No
Lidocaine-Epinephrine	Lidocaine-Epinephrine Injection Solution	No	Generic	$$$$	No
Lidocaine-Epineph-Sodium Chlor	Lidocaine-Epinephrine In Sod Chlor,Iso-Osm Injection Syringe	No	Generic	$$$$	No
Lidocaine Hcl	Lidocaine Hcl Mucosal Jelly In Applicator	No	Generic	$$$$	No
Lidocaine-Epinephrine Bit	Lidocaine-Epinephrine Bitartrate Injection Cartridge	No	Generic	$$$$	No
Lidocaine Hcl(PF) In 0.9% Nacl	Lidocaine Hcl (PF) In 0.9 % Sodium Chloride Inject Syringe	No	Generic	$$$$	No
Lidocaine Hcl	Lidocaine Hcl Intradermal Pen Injector	No	Generic	$$$$	No
Lidocaine Hcl	Lidocaine Hcl Injection Syringe	No	Generic	$$$$	No
Lidocaine Hcl	Lidocaine Hcl Injection Solution	No	Generic	$$$$	No
Lidocaine Hcl	Lidocaine Hcl Mucosal Solution	No	Generic	$$$$	No
Lidocaine Hcl In 0.9 % Nacl	Lidocaine Hcl In 0.9 % Sodium Chloride Injection Syringe	No	Generic	$$$$	No
Lidocaine-Epinephrine (PF)	Lidocaine-Epinephrine (PF) Injection Solution	No	Generic	$$$$	No
Lidomark 1-5	Lidomark 1-5 Injection And Topical Kit	No	Brand	$$$$	No
Lidomark 2-5	Lidomark 2-5 Injection And Topical Kit	No	Brand	$$$$	No
Marcaine Spinal (PF)	Marcaine Spinal (PF) Injection Solution	No	Brand	$$$$	No
Marcaine-Epinephrine	Marcaine-Epinephrine Injection Solution	No	Brand	$$$$	No
Marvona SUIK (PF)	Marvona SUIK (PF) Injection Solution, Topical Spray	No	Brand	$$$$	No
Naropin (PF)	Naropin (PF) Injection Solution	No	Brand	$$$$	No
Naropin	Naropin Injection Solution	No	Brand	$$$$	No
Nesacaine	Nesacaine Injection Solution	No	Brand	$$$$	No
Orabloc	Orabloc Injection Cartridge	No	Brand	$$$$	No
P-Care M (PF)	P-Care M (PF) Injection Kit	No	Brand	$$$$	No
P-Care MG (PF)	P-Care MG (PF) Injection Solution, Topical Spray	No	Brand	$$$$	No
P-Care X (PF)	P-Care X (PF) Injection Kit	No	Brand	$$$$	No
Polocaine	Polocaine Injection Solution	No	Brand	$$$$	No
Polocaine-MPF	Polocaine-MPF Injection Solution	No	Brand	$$$$	No
Posimir	Posimir Intra-Subacromial Injection Soln	No	Brand	$$$$	No
Readysharp Bupivacaine (PF)	Readysharp Bupivacaine (PF) Injection Kit	No	Brand	$$$$	No
Readysharp Lidocaine (PF)	Readysharp Lidocaine (PF) Injection Kit	No	Brand	$$$$	No
Ropiv-Epi-Clon-Ket-Sod Chl,Iso	Ropivacaine-Epineph-Clonid-Ketor-Sod Chl,Iso Periart Syringe	No	Generic	$$$$	No
Ropivacaine(PF)-0.9 % Sodchlor	Ropivacaine (PF) In 0.9 % Sodium Chloride Epidural Reservoir	No	Generic	$$$$	No
Ropivacaine(PF)-0.9 % Sodchlor	Ropivacaine (PF) In 0.9 % Sodium Chloride Pump Reservoir	No	Generic	$$$$	No
Ropivacaine(PF)-0.9 % Sodchlor	Ropivacaine (PF) In 0.9 % Sodium Chloride Epidural Solution	No	Generic	$$$$	No
Ropivacaine(PF)-0.9 % Sodchlor	Ropivacaine(PF)-0.9 % Sod.Chlr Infilt,Hi Var Rate Elast Pump	No	Generic	$$$$	No
Ropivacaine(PF)-0.9 % Sodchlor	Ropivacaine(PF)-0.9 % Sodchlor Infilt,Low Var Rate Elas Pump	No	Generic	$$$$	No
Ropivacaine (PF)	Ropivacaine (PF) Infiltrat,Fix Rate Elast Pump	No	Generic	$$$$	No
Ropivacaine (PF)	Ropivacaine (PF) Local Infilt,Hi Var Rate Elast Pump	No	Generic	$$$$	No
Ropivacaine (PF)	Ropivacaine (PF) Local Infl.Hi Var Rate,Pca,Elas Pmp	No	Generic	$$$$	No
Ropivacaine (PF)	Ropivacaine (PF) Injection Syringe	No	Generic	$$$$	No
Ropivacaine(PF)-0.9 % Sodchlor	Ropivacaine (PF) In 0.9 % Sodium Chloride Injection Syringe	No	Generic	$$$$	No
Ropivacaine(PF)-0.9 % Sodchlor	Ropivacaine (PF) In 0.9 % Sodium Chloride Epidural Syringe	No	Generic	$$$$	No
Ropivacaine-Ketorolac-Ketamine	Ropivacaine-Ketorolac-Ketamine Injection Syringe	No	Generic	$$$$	No
Ropivacaine-Clonidin-Ketorolac	Ropivacaine-Clonidine-Ketorolac Periarticular Syringe	No	Generic	$$$$	No
Ropivacaine (PF)-Nacl,Iso-Osm	Ropivacaine (PF) In Sodium Chlor,Iso-Osmot Epidural Solution	No	Generic	$$$$	No
Ropivacaine(PF)-0.9 % Sodchlor	Ropivacaine(PF)-0.9% Sodchlr Infil,Hi Var Rate,Pca,Elas Pump	No	Generic	$$$$	No
Ropivacaine(PF)-0.9 % Sodchlor	Ropivacaine (PF) In 0.9 % Nacl Infiltrat,Fix Rate Elast Pump	No	Generic	$$$$	No
Ropivacaine(PF)-0.9 % Sodchlor	Ropivacaine(PF)-0.9 % Nacl Inflt.Lo Var Rate,Pca,Elasto Pump	No	Generic	$$$$	No
Ropivacaine (PF)-Nacl,Iso-Osm	Ropivacaine (PF) In Sodium Chlor,Iso-Osm Injection Solution	No	Generic	$$$$	No
Sensorcaine-MPF	Sensorcaine-MPF Injection Solution	No	Brand	$$$$	No
Sensorcaine-MPF Spinal	Sensorcaine-MPF Spinal Injection Solution	No	Brand	$$$$	No
Tetracaine Hcl (PF)	Tetracaine Hcl (PF) Injection Solution	No	Generic	$$$$	No
Xylocaine	Xylocaine Injection Solution	No	Brand	$$$$	No
Xylocaine Dental-Epinephrine	Xylocaine Dental With Epinephrine Injection Cartridge	No	Brand	$$$$	No
Xylocaine With Epinephrine	Xylocaine With Epinephrine Injection Solution	No	Brand	$$$$	No
Xylocaine-MPF	Xylocaine-MPF Injection Solution	No	Brand	$$$$	No
Xylocaine-MPF/Epinephrine	Xylocaine-MPF/Epinephrine Injection Solution	No	Brand	$$$$	No
Zingo	Zingo Intradermal Pen Injector	No	Brand	$$$$	No

Alternative Drug Information

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¹Preventive care will be covered at 100 percent only when it is received from a participating provider and it is billed as preventive. A separate cost share may apply if additional medical services are received during the same visit or if your preventive care appointment becomes diagnostic in nature.

²Preventive medications on UPMC Health Plan’s Advantage Choice formulary will be covered with no cost share for members who meet certain criteria in accordance with the Patient Protection and Affordable Care Act of 2010.

³Go to www.upmchealthplan.com/BEST for award information.

⁴For details, visit upmchp.us/networkaccess.

⁵UPMC virtual counseling is available to UPMC Health Plan members who are located in Pennsylvania at the time of the visit. The service is available to members of your household who are 18 years old and older. If further counseling is needed, the counselor may refer you or your household members to relevant community resources.

⁶UPMC Health Plan members who are in Pennsylvania at the time of a virtual visit may select a UPMC-employed provider, subject to availability and discretion of the provider. Members located outside of Pennsylvania at the time of service or those who select Talk Therapy or Psychiatry services will receive care from a provider employed or contracted by Online Care Network II PC (OCN), also known as Amwell Medical Group. OCN is not an affiliate of UPMC. Limitations may apply for members of ASO plans that have opted out of coverage. Providers are not available to treat members who are in Puerto Rico.

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You searched for Lidocaine Hcl Injection Syringe.

Alternative drugs to Lidocaine Hcl may be available. Review this list with your doctor.

These alternative drugs are not covered.