nut.tx for PKU with iron no.30

62.2 G-294 — Pack

DIETARY SUPPLEMENTS

Also known as: PKU GOLIKE PLUS (4-16 YR)
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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.
Source: Excel (XLSX)  ·  Formulary date: Oct 29, 2026  ·  Checked: 10 hours, 14 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via Pku Golike Plus (4-16 Yr) 		Tier 3 - Non-Formulary — — — None
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