acoltremon

0.003 % — Drops

Also known as: TRYPTYR

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

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 20 hours, 37 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Tryptyr	Non-Preferred	—	—	—	None

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 20 hours, 37 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	✓	PA \| QL