prudoxin

5 % — CREAM (GRAM)

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: Sep 23, 2026 · Checked: 4 hours, 28 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 1 - Generic Formulary	—	—	✓ TOPICAL ZONALON, PRUDOXIN TO BE DISP AT MAX QTY OF 45 GRAMS IN 23 DAYS	QL Quantity limit