polymyxin B sulfate/trimethoprim

10,000 unit-1 mg/mL — Drops

OPHTHALMIC

Also known as: POLYMYXIN B SUL-TRIMETHOPRIM
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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: Jan 5, 2026  ·  Checked: 3 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 1 - Basic Core Formulary — — — None
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