Does Standard Silver 22 Health cover uridine triacetate?
Standard Silver 22 Health
13887-13887FL0010002-0 · ACA · ACA Marketplace
uridine triacetate
uridine triacetateunder Standard Silver 22 Health
Covered — some forms require prior authorization
1 of 2 covered forms have a condition attached. 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.
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 (2)
- uridine triacetate 10000 MG Oral Granules [Vistogard]Amount limit
- uridine triacetate 2000 MG Oral Granules [Xuriden]Approval first