vonoprazan fumarate/amoxicillin trihydrate/clarithromycin

20 mg (28)-500 mg (56)-500 mg (28) — Pack

Also known as: VOQUEZNA TRIPLE PAK

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: Jan 5, 2026 · Checked: 12 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	✓	PA \| QL