antihemophilic factor (factor VIII) recomb,B-domain deleted

1,000 (+/-) unit range, 2,000 (+/-) unit range, 250 (+/-) unit range, 500 (+/-) unit range — Vial

Also known as: XYNTHA

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: 3 hours, 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 2 - Extended Core Formulary	—	—	—	None