Reditrex

7.5 MG, 10 MG, 12.5 MG, 15 MG, 17.5 MG, 20 MG, 22.5 MG, 25 MG — SYRINGE (ML)

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: 7 hours, 12 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	—	—	✓ REDITREX SYRINGE (ML)TO BE DISP AT A MAX QUANTITY OF 4 SYRINGES AT RETAIL OR 12 SYRINGES AT MAIL	QL Quantity limit