Terumo Surguard

18GX1 1/2", 18GX1", 19GX1 1/2", 19GX1", 20GX1 1/2", 20GX1", 21 G X 1", 21GX1 1/2", 22 G X 1", 22GX1 1/2", 23GX1 1/2", 23GX1", 25GX1 1/2", 25GX1", 25GX5/8", 26GX1/2", 26GX3/8", 27GX1/2", 30GX1 1/2" — NEEDLE, DISPOSABLE

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: Excel (XLSX)  ·  Formulary date: Sep 23, 2026  ·  Checked: 8 hours, 1 minute 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
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