PREMASOL - SULFITE-FREE (AMINO ACID) 1.4/.82/.82/.78/.48/.48/.42/.34/.2/.24/1.2/.68/.54/.5/.38/.36/.32/25/.016 g/100mL/mg/100mL Injection, Solution
Also known as Leucine, Lysine, Isoleucine, Valine, Histidine, Phenylalanine, Threonine, Methionine, Tryptophan, Tyrosine, N-Acetyl-Tyrosine, Arginine, Proline, Alanine, Glutamic Acide, Serine, Glycine, Aspartic Acid, Taurine, Cysteine Hydrochloride. Coverage in American Samoa (CMS PDP Region 35).
1 of 1 stand-alone Part D plans in American Samoa cover this drug on tier 4.
1 of 1 plans apply a prior authorization, step therapy or quantity limit.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 25% | 25% | $0.1133 | — |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity.