vonoprazan/amoxicillin/clarith

20-500-500 — Pack

H. PYLORI AGENTS

Also known as: VOQUEZNA TRIPLE PAK
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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.
Source: Excel (XLSX)  ·  Formulary date: Oct 29, 2026  ·  Checked: 5 hours, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via Voquezna Triple Pak 		Tier 3 - Non-Formulary ✓ — ✓ VOQUEZNA TRIPLE PAK TO BE DISP AT A MAXIMUM QUANTITY OF 112 UNITS IN 14 DAYS PA | QL PA: PA DRUGS, DOD PA REQUIRED; Quantity limit
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