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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 2 - Brand Formulary | ✓ | — | ✓ BUCCAL SITAVIG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 2 TABLETS IN 21 DAYS | PA | QL PA: 1270/48001/90693 PA DRUGS, DOD PA REQUIRED; Quantity limit |