losartan potassium/hydrochlorothiazide

100 mg-12.5 mg, 100 mg-25 mg, 50 mg-12.5 mg — Tablet

Also known as: HYZAAR LOSARTAN-HYDROCHLOROTHIAZIDE

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: 3 hours, 36 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 1 - Basic Core Formulary	✓	—	—	PA