FillMapGold 22 Health

Does Gold 22 Health cover deutetrabenazine?

Gold 22 Health
13887-13887FL0010001-0 · ACA · ACA Marketplace
deutetrabenazine
deutetrabenazineunder Gold 22 Health
Covered — requires prior authorization
Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
$250per 30-day fill

From the first fill — no deductible on this drug.

This is the standard amount. If you qualified for a cost-sharing reduction when you enrolled, set your level above and this will follow it.

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
Specialty drugs
Approval first
Required
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 (13)

  • {14 (24 HR deutetrabenazine 12 MG Extended Release Oral Tablet [Austedo]) / 14 (24 HR deutetrabenazine 24 MG Extended Release Oral Tablet [Austedo]) / 14 (24 HR deutetrabenazine 6 MG Extended Release Oral Tablet [Austedo]) } Pack [Austedo XR Once Daily, 4 Week Titration Pack, 6 MG / 12 MG / 24 MG]Approval first
  • {7 (24 HR deutetrabenazine 12 MG Extended Release Oral Tablet [Austedo]) / 7 (24 HR deutetrabenazine 18 MG Extended Release Oral Tablet [Austedo]) / 7 (24 HR deutetrabenazine 24 MG Extended Release Oral Tablet [Austedo]) / 7 (24 HR deutetrabenazine 30 MG Extended Release Oral Tablet [Austedo]) } Pack [Austedo XR Once Daily, 4 Week Titration Pack, 12 MG / 18 MG / 24 MG / 30 MG]Approval first
  • 24 HR deutetrabenazine 12 MG Extended Release Oral Tablet [Austedo]Approval firstAmount limit
  • 24 HR deutetrabenazine 18 MG Extended Release Oral Tablet [Austedo]Approval firstAmount limit
  • 24 HR deutetrabenazine 24 MG Extended Release Oral Tablet [Austedo]Approval firstAmount limit
  • 24 HR deutetrabenazine 30 MG Extended Release Oral Tablet [Austedo]Approval firstAmount limit
  • 24 HR deutetrabenazine 36 MG Extended Release Oral Tablet [Austedo]Approval firstAmount limit
  • 24 HR deutetrabenazine 42 MG Extended Release Oral Tablet [Austedo]Approval firstAmount limit
  • 24 HR deutetrabenazine 48 MG Extended Release Oral Tablet [Austedo]Approval firstAmount limit
  • 24 HR deutetrabenazine 6 MG Extended Release Oral Tablet [Austedo]Approval firstAmount limit
  • deutetrabenazine 12 MG Oral Tablet [Austedo]Approval firstAmount limit
  • deutetrabenazine 6 MG Oral Tablet [Austedo]Approval firstAmount limit
  • deutetrabenazine 9 MG Oral Tablet [Austedo]Approval firstAmount limit

← All coverage for deutetrabenazine