obstetrix dha
Generic: prenatal vitamins no.12/iron carbonyl/levomefolate calc/dha
29-1-50 MG — COMBINATION PACKAGE, TABLET AND DR CAP
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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
2 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
TRICARE Uniform Formulary 2026
via PNV 12/iron/lmefolate calc/dha |
Tier 3 - Non-Formulary | — | — | ✓ SEL TEST STRIPS TO DISP AT MAX OF 100 UNITS IN 22D OR 300 UNITS IN 68D W/O QF IN 365D OR RX BY OBGYN | QL Quantity limit |
| TRICARE Uniform Formulary 2026 | Tier 3 - Non-Formulary | ✓ | — | ✓ SEL TEST STRIPS TO DISP AT MAX OF 100 UNITS IN 22D OR 300 UNITS IN 68D W/O QF IN 365D OR RX BY OBGYN | PA | QL PA: FEDERAL LEGEND PRENATALS FOR FEMALES > 45 YEARS PA REQUIRED; Quantity limit |