Does NH Local Choice HMO Gold 1400 + $0 Rx list + $0 Virtual Urgent Care cover epoetin alfa?
NH Local Choice HMO Gold 1400 + $0 Rx list + $0 Virtual Urgent Care
59025-59025NH0370104-0 · ACA · ACA Marketplace
epoetin alfa
epoetin alfaunder NH Local Choice HMO Gold 1400 + $0 Rx list + $0 Virtual Urgent Care
Covered — requires prior authorization
Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
30%of the price your plan negotiates
Medicare hasn’t published this plan’s negotiated price for this drug yet — that file is updated every three months, and newly launched drugs appear in it late. Your pharmacy can quote the exact amount today. 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
- Non preferred brand
- 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