Austedo Xr Titration KT(WK1-4)

12-18-24MG, 6-12-24 MG — TABLET, EXTENDED RELEASE 24 HR DOSE PACK

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: 9 hours, 1 minute ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 2 - Brand Formulary	✓	—	—	PA PA: 1270/48001/90693 PA DRUGS, DOD PA REQUIRED