Assure Haemolance Plus

1.2 MM, 18 GAUGE, 21 GAUGE, 25 GAUGE, 28 GAUGE — Device

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: Sep 23, 2026 · Checked: 7 hours, 12 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 2 - Brand Formulary	—	—	✓ SELECT LANCETS TO BE DISP AT MAX QTY OF 204 UNITS IN 22 DAYS OR 612 UNITS IN 68 DAYS	QL Quantity limit