Cobenfy Starter Pack

Generic: xanomeline tart/trospium chlor

50-100-20 — CAP DS PK

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, 56 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	—	PA PA: TPA - SELECT DRUGS REQUIRES PRIOR AUTHORIZATION (NEW TO MARKET DRUGS)