prenatal vitamins no.33/iron polysach complex/folic acid/dha

29 mg iron-1 mg-250 mg — Pack

Also known as: SELECT-OB + DHA

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: 3 hours, 34 minutes ago

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