prenatal vitamins no.85/iron asparto glycin/folate no.1/dha

10 mg iron-1 mg-200 mg — Capsule

Also known as: PRENATE PIXIE

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: 1 hour, 58 minutes ago

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