FillMapStandard Silver 22 Health · 13887-13887FL0010002-0About this plan

Does Standard Silver 22 Health cover momelotinib?

1 · Your plan

Standard Silver 22 Health

13887-13887FL0010002-0 · ACA · ACA Marketplace

2 · Your medication

momelotinib

momelotinibunder Standard Silver 22 Health

Covered — requires prior authorization

Your plan has to approve it first — your doctor’s office handles it.

What you'd pay

$350per 30-day fill

Your plan’s deductible comes first — you pay the full price until it is met.

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.

Tier: Specialty drugs
Approval first: Required
Try another first: No
Amount limit: None

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.

Your cost-sharing levelMarketplace plans publish a different amount for each level. Your eligibility notice says which applies. Nothing here is saved.

Covered forms and strengths (3)

momelotinib 100 MG Oral Tablet [Ojjaara]Approval first
momelotinib 150 MG Oral Tablet [Ojjaara]Approval first
momelotinib 200 MG Oral Tablet [Ojjaara]Approval first

← All coverage for momelotinib