methotrexate/PF

10 mg/0.2 mL, 10 mg/0.4 mL, 12.5 mg/0.25 mL, 12.5 mg/0.4 mL, 15 mg/0.3 mL, 15 mg/0.4 mL, 17.5 mg/0.35 mL, 17.5 mg/0.4 mL, 20 mg/0.4 mL, 22.5 mg/0.4 mL, 22.5 mg/0.45 mL, 25 mg/0.4 mL, 25 mg/0.5 mL, ... — Auto-Injector

ANTIRHEUMATICS

Also known as: OTREXUP RASUVO

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 16 hours, 10 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 3 - Non-Formulary PA
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