B-d Safetyglide

18GX1 1/2", 21 G X 1", 21GX1 1/2", 23GX1 1/2", 23GX1", 25GX1", 25GX5/8", 27GX5/8", 29 G X1/2", 30 GX5/16", 31 GX5/16" — NEEDLE, DISPOSABLE

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: 8 hours, 1 minute ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 2 - Brand Formulary	—	—	✓ SELECT SYRINGES,NEEDLES,SUPPLIES TO BE DISPENSED AT MAX QTY OF 200 UNITS IN 22D OR 600 UNITS IN 68D	QL Quantity limit