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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 1 - Generic Formulary | — | — | ✓ ULTRAM 50MG,ULTRACET,RYBIX TO BE DISP AT A MAX QTY OF 240 TABS IN 22 DAYS OR 720 TABS IN 68 DAYS | QL Quantity limit |