Terumo Hypodermic Needle-syrin

20GX1 1/2", 20GX1", 21 G X 1", 21GX1 1/2", 22 G X 1", 22GX1 1/2" — SYRINGE, EMPTY DISPOSABLE

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: 9 hours, 2 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 2 - Brand Formulary	—	—	✓ SELECT SYRINGES,NEEDLES,SUPPLIES TO BE DISPENSED AT MAX QTY OF 200 UNITS IN 22D OR 600 UNITS IN 68D	QL Quantity limit