FillMapBSW Diabetes Care Gold HMO 014

Does BSW Diabetes Care Gold HMO 014 cover epoetin alfa?

BSW Diabetes Care Gold HMO 014
40788-40788TX0460014-0 · ACA · ACA Marketplace
epoetin alfa
epoetin alfaunder BSW Diabetes Care Gold HMO 014
Covered — requires prior authorization
Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
$500per 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.

Tier
Specialty
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.

Covered forms and strengths (20)

  • 1 ML epoetin alfa 10000 UNT/ML Injection [Epogen]Approval first
  • 1 ML epoetin alfa 10000 UNT/ML Injection [Procrit]Approval first
  • 1 ML epoetin alfa 2000 UNT/ML Injection [Epogen]Approval first
  • 1 ML epoetin alfa 2000 UNT/ML Injection [Procrit]Approval first
  • 1 ML epoetin alfa 3000 UNT/ML Injection [Epogen]Approval first
  • 1 ML epoetin alfa 3000 UNT/ML Injection [Procrit]Approval first
  • 1 ML epoetin alfa 4000 UNT/ML Injection [Epogen]Approval first
  • 1 ML epoetin alfa 4000 UNT/ML Injection [Procrit]Approval first
  • 1 ML epoetin alfa 40000 UNT/ML Injection [Procrit]Approval first
  • 1 ML epoetin alfa-epbx 10000 UNT/ML Injection [Retacrit]Approval first
  • 1 ML epoetin alfa-epbx 2000 UNT/ML Injection [Retacrit]Approval first
  • 1 ML epoetin alfa-epbx 3000 UNT/ML Injection [Retacrit]Approval first
  • 1 ML epoetin alfa-epbx 4000 UNT/ML Injection [Retacrit]Approval first
  • 1 ML epoetin alfa-epbx 40000 UNT/ML Injection [Retacrit]Approval first
  • epoetin alfa 10000 UNT/ML Injectable Solution [Epogen]Approval first
  • epoetin alfa 10000 UNT/ML Injectable Solution [Procrit]Approval first
  • epoetin alfa 20000 UNT/ML Injectable Solution [Epogen]Approval first
  • epoetin alfa 20000 UNT/ML Injectable Solution [Procrit]Approval first
  • epoetin alfa-epbx 10000 UNT/ML Injectable Solution [Retacrit]Approval first
  • epoetin alfa-epbx 20000 UNT/ML Injectable Solution [Retacrit]Approval first

← All coverage for epoetin alfa