lancets/blood glucose strips

30 GAUGE — Pack

Also known as: FORA V10-V12-D10-D20 GOJJI LANCET-GLUCOSE TEST STRP

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

2 plans

Source: Excel (XLSX) · Formulary date: Oct 29, 2026 · Checked: 5 hours, 32 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via Fora V10-V12-D10-D20	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