multivitamin-min/folate/omega-3/dha/epa/fish oil/herb no.319

170 mcg DFE-650 mg-240 mg-360 mg-1 gram-500 mg — Pack

Also known as: ACTIVESSENTIALS ACTIVESSENTIALS-CALCIUM

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: 16 hours, 11 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	—	—	—	None