Does Gold 22 Health cover dalteparin?
Gold 22 Health
13887-13887FL0010001-0 · ACA · ACA Marketplace
dalteparin
dalteparinunder Gold 22 Health
Covered — just walk in
Nothing to clear first — take the prescription to an in-network pharmacy.
What you'd pay
This plan doesn't publish a price for this tier. Your pharmacy can quote it before you fill.
Amount limit applies — you can still fill it, but your plan caps how much you get at a time. This plan's drug list records the cap without stating the amount — your pharmacy can tell you when they fill it.
- Tier
- Non preferred brands
- Approval first
- Not needed
- Try another first
- No
- Amount limit
- Yes
Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 14, 2026 · CMS QHP machine-readable. Reference information, not medical advice and not a price.
Covered forms and strengths (9)
- 0.2 ML dalteparin sodium 12500 UNT/ML Prefilled Syringe [Fragmin]Amount limit
- 0.2 ML dalteparin sodium 25000 UNT/ML Prefilled Syringe [Fragmin]Amount limit
- 0.3 ML dalteparin sodium 25000 UNT/ML Prefilled Syringe [Fragmin]Amount limit
- 0.5 ML dalteparin sodium 25000 UNT/ML Prefilled Syringe [Fragmin]Amount limit
- 0.6 ML dalteparin sodium 25000 UNT/ML Prefilled Syringe [Fragmin]Amount limit
- 0.72 ML dalteparin sodium 25000 UNT/ML Prefilled Syringe [Fragmin]Amount limit
- 1 ML dalteparin sodium 10000 UNT/ML Prefilled Syringe [Fragmin]Amount limit
- 4 ML dalteparin sodium 2500 UNT/ML Injection [Fragmin]Amount limit
- dalteparin sodium 25000 UNT/ML Injectable Solution [Fragmin]Amount limit