doxylamine succinate/vit B6

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

Also known as: DICLEGIS BONJESTA DOXYLAMINE SUCC-PYRIDOXINE HCL

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: Jul 31, 2026 · Checked: 2 hours, 54 minutes ago

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