prenatal vit no.100/iron ps cplex,sod EDTA/folic acid/omega3

27 mg iron-1 mg-374 mg — Pack

Also known as: BAL-CARE DHA ESSENTIAL

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: 22 hours, 26 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	—	PA