vonoprazan/amoxicillin/clarith

20-500-500 — 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: Jul 31, 2026 · Checked: 3 hours, 40 minutes ago

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