amino acid 3 % no.2 pedi/dextrose 10 %/calcium gluc/heparin

3 %-10 %-2.33 mEq-125 unit/250 mL — Solution

Also known as: AA 3%-D10W-LOW CALCIUM-HEPARIN

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: Jan 5, 2026 · Checked: 12 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	—	—	—	None