brimonidine tartrate/dorzolamide HCl

0.1 %-2 % — Drops

Also known as: BRIMONIDINE-DORZOLAMIDE

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: May 29, 2026 · Checked: 11 hours, 54 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	—	—	—	None