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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.
TRICARE
1 plan| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| TRICARE Uniform Formulary 2026 | Tier 3 - Non-Formulary | ✓ | — | ✓ SEL TEST STRIPS TO DISP AT MAX OF 100 UNITS IN 22D OR 300 UNITS IN 68D W/O QF IN 365D OR RX BY OBGYN | PA | QL PA: TPA - FEDERAL LEGEND PRENATALS FOR FEMALES OF ALL AGES REQUIRES PRIOR AUTHORIZATION; Quantity limit |