Fora V10-V12-D10-D20

Generic: lancets/blood glucose strips

30 GAUGE — Pack

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

3 plans

Source: Excel (XLSX) · Formulary date: Sep 23, 2026 · Checked: 8 hours, 54 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via INFINITY TEST STRIPS	Tier 3 - Non-Formulary	✓	—	✓ SEL TEST STRIPS TO DISP AT MAX OF 100 UNITS IN 22D OR 300 UNITS IN 68D W/O QF IN 365D OR RX BY OBGYN	PA \| QL PA: SELECT BLOOD GLUCOSE TEST STRIPS REQUIRES PRIOR AUTHORIZATION; Quantity limit
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	—	PA PA: SELECT BLOOD GLUCOSE TEST STRIPS REQUIRES PRIOR AUTHORIZATION
TRICARE Uniform Formulary 2026 via Gojji Lancet-glucose Test Strp	Tier 3 - Non-Formulary	✓	—	—	PA PA: SELECT BLOOD GLUCOSE TEST STRIPS REQUIRES PRIOR AUTHORIZATION