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Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
TRICARE
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
TRICARE Uniform Formulary 2026
via Norixa |
Tier 3 - Non-Formulary | — | — | — | None |
|
TRICARE Uniform Formulary 2026
via Minovia |
Tier 3 - Non-Formulary | — | — | — | None |
| TRICARE Uniform Formulary 2026 | Tier 3 - Non-Formulary | — | — | — | None |