olmesartan/amlodipin/hcthiazid

20-5-12.5, 40-10-12.5, 40-10-25MG, 40-5-12.5, 40-5-25 MG — Tablet

Also known as: TRIBENZOR OLMESARTAN-AMLODIPINE-HCTZ Olmesartan-amlodipine-hctz

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: Oct 29, 2026 · Checked: 5 hours, 35 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	✓	—	PA \| ST PA: TPA - ALDACTONE TABLET FOR MALE PTS 11 THRU 18 YRS OF AGE W/O QUALIFIERS IN 360 DAYS REQ PA; Step therapy: ST RAA RX<1/180, DOD PA REQUIRED