FillMapGold 22 Health

Does Gold 22 Health cover memantine?

Gold 22 Health
13887-13887FL0010001-0 · ACA · ACA Marketplace
memantine
memantineunder Gold 22 Health
Covered — some forms require step therapy
9 of 15 covered forms have a condition attached. You may need to try a cheaper medication first — your doctor’s office handles it.
What you'd pay
$15per 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
Generics
Approval first
Not needed
Try another first
Required
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 (15)

  • {21 (memantine hydrochloride 10 MG Oral Tablet [Namenda]) / 28 (memantine hydrochloride 5 MG Oral Tablet [Namenda]) } Pack [Namenda 49 Titration Pack]Amount limit
  • {21 (memantine hydrochloride 10 MG Oral Tablet) / 28 (memantine hydrochloride 5 MG Oral Tablet) } PackAmount limit
  • {7 (24 HR memantine hydrochloride 14 MG Extended Release Oral Capsule [Namenda]) / 7 (24 HR memantine hydrochloride 21 MG Extended Release Oral Capsule [Namenda]) / 7 (24 HR memantine hydrochloride 28 MG Extended Release Oral Capsule [Namenda]) / 7 (24 HR memantine hydrochloride 7 MG Extended Release Oral Capsule [Namenda]) } Pack [Namenda 28 Titration Pack]Try another firstAmount limit
  • 24 HR memantine hydrochloride 14 MG Extended Release Oral CapsuleTry another firstAmount limit
  • 24 HR memantine hydrochloride 14 MG Extended Release Oral Capsule [Namenda]Try another firstAmount limit
  • 24 HR memantine hydrochloride 21 MG Extended Release Oral CapsuleTry another firstAmount limit
  • 24 HR memantine hydrochloride 21 MG Extended Release Oral Capsule [Namenda]Try another firstAmount limit
  • 24 HR memantine hydrochloride 28 MG Extended Release Oral CapsuleTry another firstAmount limit
  • 24 HR memantine hydrochloride 28 MG Extended Release Oral Capsule [Namenda]Try another firstAmount limit
  • 24 HR memantine hydrochloride 7 MG Extended Release Oral CapsuleTry another firstAmount limit
  • 24 HR memantine hydrochloride 7 MG Extended Release Oral Capsule [Namenda]Try another firstAmount limit
  • memantine hydrochloride 10 MG Oral TabletAmount limit
  • memantine hydrochloride 10 MG Oral Tablet [Namenda]Amount limit
  • memantine hydrochloride 2 MG/ML Oral SolutionAmount limit
  • memantine hydrochloride 5 MG Oral TabletAmount limit

← All coverage for memantine