doxylamine succinate/pyridoxine HCl (vitamin B6)

10 mg-10 mg, 20 mg-20 mg — Delayed Release Tablet

Also known as: DICLEGIS DOXYLAMINE SUCC-PYRIDOXINE HCL BONJESTA

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: 5 hours, 15 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	—	PA