acetaminophen with codeine

300MG-30MG — Tablet

Also known as: Acetaminophen-codeine

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

1 plan

Source: Excel (XLSX) · Formulary date: Oct 29, 2026 · Checked: 5 hours, 19 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 1 - Generic Formulary (Basic Core)	—	—	—	None