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You searched for Virt-Gard Tablet.

Virt-Gard At a Glance
Covered:	No
Your Cost*:	$$$$
Notices?:	No
* Your cost reflects copayment amount for drug. Individuals with high deductible plans may pay full cost of drug until deductible is met.

Strength:

Virt-Gard 2.2 mg-25 mg-1 mg tablet

Virt-Gard 2.2 mg-25 mg-1 mg tablet

Virt-Gard is not included in this formulary. Member pays full cost.

Drug Name	Drug Form	Covered	Type	Your Cost*	Notices?
Dialyvite	Dialyvite Tablet	Yes	Brand	$$$$	No
Folic Acid-Vit B6-Vit B12	Folic Acid-Vit B6-Vit B12 Tablet	Yes	Generic	$$$$	No
L-Methyl-MC	L-Methyl-MC Tablet	Yes	Brand	$$$$	No
L-Methylfolate Ca P-5-P Me-Cbl	L-Methylfolate Ca P-5-P Me-Cbl Capsule	Yes	Brand	$$$$	No
LMTHF-Pyridoxine-Cyanocobalamn	LMTHF-Pyridoxine-Cyanocobalamin Tablet	Yes	Brand	$$$$	No
Mynephrocaps	Mynephrocaps Capsule	Yes	Brand	$$$$	No
Renal Caps	Renal Caps Capsule	Yes	Brand	$$$$	No
Folbee	Folbee Tablet	Yes	Brand	$$$$	No
Folbic	Folbic Tablet	Yes	Brand	$$$$	No
Folplex 2.2	Folplex 2.2 Tablet	Yes	Brand	$$$$	No
Reno Caps	Reno Caps Capsule	Yes	Brand	$$$$	No

Drug Name	Drug Form	Covered	Type	Your Cost*	Notices?
B Complex 100	B Complex 100 Injectable Solution	No	Generic	$$$$	No
Cardiotek-RX (Bioperine)	Cardiotek-RX (Bioperine) Tablet	No	Brand	$$$$	No
Cerefolin	Cerefolin Tablet	No	Brand	$$$$	No
B12-Levomefolate Calcium-B6	Cyanocobalamin-Levomefolate Cal-Pyridoxine Tablet	No	Generic	$$$$	No
DIALYVITE 3000	DIALYVITE 3000 Tablet	No	Brand	$$$$	No
Dialyvite 5000	Dialyvite 5000 Tablet	No	Brand	$$$$	No
Dialyvite Supreme D	Dialyvite Supreme D Tablet	No	Brand	$$$$	No
Fabb	Fabb Tablet	No	Brand	$$$$	No
Folbee Plus	Folbee Plus Tablet	No	Brand	$$$$	No
Folgard RX	Folgard RX Tablet	No	Brand	$$$$	No
Levomefol-B6-Meb12-Algal Oil	Levomefolate Ca-B6-Meb12-Algal Oil Capsule	No	Generic	$$$$	No
Metanx (Algal Oil)	Metanx (Algal Oil) Capsule	No	Brand	$$$$	No
Methaver	Methaver Capsule	No	Brand	$$$$	No
Nephplex Rx	Nephplex Rx Tablet	No	Brand	$$$$	No
Nephro-Vite Rx	Nephro-Vite Rx Tablet	No	Brand	$$$$	No
Nephrocaps	Nephrocaps Capsule	No	Brand	$$$$	No
Potaba	Potaba Capsule	No	Brand	$$$$	No
Rena-Vite Rx	Rena-Vite Rx Tablet	No	Brand	$$$$	No
Supervite	Supervite Oral Liquid	No	Brand	$$$$	No
TL Gard Rx	TL Gard Rx Tablet	No	Brand	$$$$	No
Triphrocaps	Triphrocaps Capsule	No	Brand	$$$$	No
Virt-Caps	Virt-Caps Capsule	No	Brand	$$$$	No
Virt-Gard	Virt-Gard Tablet	No	Brand	$$$$	No
Virt-Vite	Virt-Vite Tablet	No	Brand	$$$$	No
Virt-Vite Forte	Virt-Vite Forte Tablet	No	Brand	$$$$	No
Virt-Vite Plus	Virt-Vite Plus Tablet	No	Brand	$$$$	No
Vita-Respa	Vita-Respa Tablet	No	Brand	$$$$	No
Vital-D Rx	Vital-D Rx Tablet	No	Brand	$$$$	No
Vol-Care Rx	Vol-Care Rx Tablet	No	Brand	$$$$	No
VP-Vite Rx	VP-Vite Rx Tablet	No	Brand	$$$$	No

Alternative Drug Information

The value of choosing UPMC Health Plan

At UPMC Health Plan, we support our members in focusing on their total well-being. We want to make sure our members have everything you need to be as healthy and happy as possible. We do this by:

Providing access to care to help keep you healthy.

	$0 preventive care that covers many health services for adults and children at 100 percent.¹
	Coverage for high-value generic and no-cost preventive medications.²
	Access to top-ranked doctors and hospitals and an extended network.³

Taking care of your mental and physical health.

	Six free counseling sessions through LifeSolutions®.⁴
	Free health coaching to help you make healthy changes in your life.
	The RxWell® app provides virtual support for your total well-being.

Supporting you when you need it.

	24/7 virtual urgent care and connections to pharmacists, health coaches, and behavioral health concierges. Designed to fit your schedule, it's covered at 100 percent by most plans.⁵
	The UPMC Health Plan app for easy access to your health insurance information.
	Our exceptional Health Care Concierge team for help navigating your benefits with a quick online chat or phone call.

¹Preventive care will be covered at 100 percent only when it is received from a participating provider and it is billed as preventive. A separate cost share may apply if additional medical services are received during the same visit or if your preventive care appointment becomes diagnostic in nature.

²Preventive medications on UPMC Health Plan’s Advantage Choice formulary will be covered with no cost share for members who meet certain criteria in accordance with the Patient Protection and Affordable Care Act of 2010.

³Go to www.upmchealthplan.com/BEST for award information.

⁴Only the virtual visit with the provider will be covered at 100 percent. Prescription drug and other costs related to the visit or recommended by the provider will not be included in the virtual visit coverage and will be your responsibility. If you are enrolled in the UPMC Advantage Silver HSA $4,000/$0, UPMC Advantage Gold HSA $2,500/10%, or UPMC Advantage Catastrophic $9,200/$0 plan, UPMC AnywhereCare virtual visits will be covered at 100 percent after you meet your deductible. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.

⁵UPMC Health Plan members who are in Pennsylvania at the time of a virtual visit may select a UPMC-employed provider, subject to availability and discretion of the provider. Members located outside of Pennsylvania at the time of service or those who select Talk Therapy or Psychiatry services will receive care from a provider employed or contracted by Online Care Network II PC (OCN), also known as Amwell Medical Group. OCN is not an affiliate of UPMC. Limitations may apply for members of ASO plans that have opted out of coverage. Providers are not available to treat members who are in Puerto Rico.

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You searched for Virt-Gard Tablet.

Alternative drugs to Virt-Gard may be available. Review this list with your doctor.

These alternative drugs are not covered.