amoxicillin/potassium clav

200-28.5/5, 250-125 MG, 250-62.5/5, 400-57MG/5, 500-125 MG, 600-42.9/5, 875-125 MG — Tablet

Also known as: Amoxicillin-clavulanate Potass

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, 23 minutes ago

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