allergenic extract, mite-D.farinae-D.pteronyssinus,standard

12 standardized quality-house dust mite — Sublingual Tablet

IMMUNOLOGICAL AGENTS MISCELLANEOUS

Also known as: ODACTRA

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 5 hours, 7 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 3 - Non-Formulary PA
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