Does DakotaBlue Altru Gold ($5 Value Based Drug List) cover orlistat?
DakotaBlue Altru Gold ($5 Value Based Drug List)
37160-37160ND2480001-0 · ACA · ACA Marketplace
orlistat
orlistatunder DakotaBlue Altru Gold ($5 Value Based Drug List)
Covered — requires prior authorization
Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
$100per 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
- Non preferred brand
- 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)
- orlistat 120 MG Oral CapsuleApproval firstAmount limit
- orlistat 120 MG Oral Capsule [Xenical]Approval firstAmount limit