FillMapStandard Silver + Vision + Adult Dental

Does Standard Silver + Vision + Adult Dental cover leuprolide?

Standard Silver + Vision + Adult Dental
91450-91450AZ0180105-0 · ACA · ACA Marketplace
leuprolide
leuprolideunder Standard Silver + Vision + Adult Dental
Covered — requires prior authorization
Your plan has to approve it first — your doctor’s office handles it.
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
Medicalservicedrugs
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 (21)

  • 0.25 ML leuprolide acetate 30 MG/ML Prefilled Syringe [Eligard]Approval firstAmount limit
  • 0.25 ML leuprolide acetate 30 MG/ML Prefilled Syringe [Vabrinty]Approval firstAmount limit
  • 0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Eligard]Approval firstAmount limit
  • 0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Fensolvi]Approval first
  • 0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Vabrinty]Approval firstAmount limit
  • 0.375 ML leuprolide acetate 60 MG/ML Prefilled Syringe [Eligard]Approval firstAmount limit
  • 0.375 ML leuprolide acetate 60 MG/ML Prefilled Syringe [Vabrinty]Approval firstAmount limit
  • 0.5 ML leuprolide acetate 60 MG/ML Prefilled Syringe [Eligard]Approval firstAmount limit
  • 0.5 ML leuprolide acetate 60 MG/ML Prefilled Syringe [Vabrinty]Approval firstAmount limit
  • 1 ML leuprolide acetate 11.25 MG/ML Prefilled Syringe [Lupron]Approval firstAmount limit
  • 1 ML leuprolide acetate 15 MG/ML Prefilled Syringe [Lupron]Approval firstAmount limit
  • 1 ML leuprolide acetate 3.75 MG/ML Prefilled Syringe [Lupron]Approval firstAmount limit
  • 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron]Approval firstAmount limit
  • 1.5 ML leuprolide acetate 15 MG/ML Prefilled Syringe [Lupron]Approval firstAmount limit
  • 1.5 ML leuprolide acetate 30 MG/ML Prefilled Syringe [Lupron]Approval firstAmount limit
  • 1.5 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron]Approval firstAmount limit
  • 3-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron]Approval firstAmount limit
  • 4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron]Approval firstAmount limit
  • leuprolide 42 MG Prefilled Syringe [Camcevi]Approval first
  • leuprolide acetate 5 MG/ML Injectable SolutionApproval firstAmount limit
  • Pediatric 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron]Approval firstAmount limit

← All coverage for leuprolide