butalbital/acetaminophen/caffeine

50 mg-325 mg-40 mg — Tablet

Also known as: BUTALBITAL-ACETAMINOPHEN-CAFFE ESGIC

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: 4 hours, 57 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 1 - Basic Core Formulary	—	—	—	None