donepezil hcl

10 mg, 10 mg/24 hour, 5 mg, 5 mg/24 hour — Tablet

Also known as: donepezil hcl oral tablet 10 mg, 5 donepezil hcl oral tablet dispersible ADLARITY DONEPEZIL HCL ODT

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: 19 hours, 16 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 2 - Extended Core Formulary	✓	—	—	PA

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 19 hours, 16 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UnitedHealthcare NC Individual & Family 2026	Unknown	—	—	✓	QL