A non-government resource built from CMS public data
ELMIRON 100 mg Capsule, Gelatin Coated
Also known as Pentosan Polysulfate Sodium. Coverage in American Samoa (CMS PDP Region 35).
Not on any stand-alone Part D formulary in American Samoa
None of the 1 stand-alone Part D (PDP) plans in CMS PDP Region 35 list this drug. On one of those plans the patient would pay the full retail price, or you would need a formulary exception.