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You searched for Allergen Ext,Kentucky Blue-June Grass Pollen Inject Solution.

All.Xt,Kblue-June Grass Pollen 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:

allergen xt,Kentucky Blue-June grass pollen 100,000 BAU/mL inject soln

allergen xt,Kentucky Blue-June grass pollen 100,000 BAU/mL inject soln

All.Xt,Kblue-June Grass Pollen is not included in this formulary. Member pays full cost.

Drug Name	Drug Form	Covered	Type	Your Cost*	Notices?
Oralair	Oralair Sublingual Tablet	Yes	Brand	$$$$	Yes
Grastek	Grastek Sublingual Tablet	Yes	Brand	$$$$	Yes
Odactra	Odactra Sublingual Tablet	Yes	Brand	$$$$	Yes
Palforzia (Level 11 Up-Dose)	Palforzia (Level 11 Up-Dose) Oral Powder Packet	Yes	Brand	$$$$	Yes
Palforzia Initial (1-3 Yrs)	Palforzia Initial (1-3 Yrs) Sprinkle Capsule	Yes	Brand	$$$$	No
Ragwitek	Ragwitek Sublingual Tablet	Yes	Brand	$$$$	Yes
Palforzia (Level 0)	Palforzia (Level 0) Sprinkle Capsule	Yes	Brand	$$$$	Yes
Palforzia (Level 1)	Palforzia (Level 1) Sprinkle Capsule	Yes	Brand	$$$$	Yes
Palforzia (Level 2)	Palforzia (Level 2) Sprinkle Capsule	Yes	Brand	$$$$	Yes
Palforzia (Level 3)	Palforzia (Level 3) Sprinkle Capsule	Yes	Brand	$$$$	Yes
Palforzia (Level 4)	Palforzia (Level 4) Sprinkle Capsule	Yes	Brand	$$$$	Yes
Palforzia (Level 5)	Palforzia (Level 5) Sprinkle Capsule	Yes	Brand	$$$$	Yes
Palforzia (Level 6)	Palforzia (Level 6) Sprinkle Capsule	Yes	Brand	$$$$	Yes
Palforzia (Level 7)	Palforzia (Level 7) Sprinkle Capsule	Yes	Brand	$$$$	Yes
Palforzia (Level 8)	Palforzia (Level 8) Sprinkle Capsule	Yes	Brand	$$$$	Yes
Palforzia (Level 9)	Palforzia (Level 9) Sprinkle Capsule	Yes	Brand	$$$$	Yes
Palforzia (Level 10)	Palforzia (Level 10) Sprinkle Capsule	Yes	Brand	$$$$	Yes
Palforzia Level 11 Maintenance	Palforzia (Level 11 Maintenance) Oral Powder Packet	Yes	Brand	$$$$	Yes
Palforzia Initial (4-17 Yrs)	Palforzia Initial (4-17 Yrs) Sprinkle Capsule	Yes	Brand	$$$$	Yes

Drug Name	Drug Form	Covered	Type	Your Cost*	Notices?
Allerg Xt,D.Farinae-D.Pteronys	Allergen Xt,Mite,D.Farinae-D.Pteronyssinus Injection Soln	No	Generic	$$$$	No
Allerg Xt,Grass-Meadow Fescue	Allergen Ext,Grass Pollen-Meadow Fescue Injection Solution	No	Generic	$$$$	No
Allergen Ext-Aureoba.Pullulans	Allergen Extract-Aureobasidium Pullulans Injection Solution	No	Generic	$$$$	No
Allergen Ext-T. Mentagrophytes	Allergenic Extract-Trichophyton Mentagrophytes Inj Solution	No	Generic	$$$$	No
Allerg Xt-Sheep Sor,Yellw Dock	Allerg Xt-Weed Pollen-Sheep Sorrel,Yellw Dock Injection Soln	No	Generic	$$$$	No
Allergen Ext-English Plantain	Allergen Ext,Weed Pollen-English Plantain Injection Solution	No	Generic	$$$$	No
Allerg Ex,Grass Pollen-Bermuda	Allergenic Extract,Grass Pollen-Bermuda Injection Solution	No	Generic	$$$$	No
Allerg Ext,Grass Pollen-Redtop	Allergen Extract,Grass Pollen-Redtop Injection Solution	No	Generic	$$$$	No
Allerg Xt,Grass Pollen-Timothy	Allergen Extract,Grass Pollen-Timothy Injection Solution	No	Generic	$$$$	No
Allergen Ext-C.Cladosporioides	Allergen Extract-Cladosporium Cladosporioides Injection Soln	No	Generic	$$$$	No
Allergen Extract-D.Sorokiniana	Allergenic Extract-Drechslera Sorokiniana Injection Solution	No	Generic	$$$$	No
Allergen Ex-Fusarium Oxysporum	Allergenic Extract-Fusarium Oxysporum Injection Solution	No	Generic	$$$$	No
Allerg Ex,Grass Pollen-Orchard	Allergenic Extract-Grass Pollen,Orchard Injection Solution	No	Generic	$$$$	No
Allergn Ext-Mount.Cedar Pollen	Allergen Ext-Mountain Cedar Tree Pollen Injection Solution	No	Generic	$$$$	No
Allergen Extract-S. Cerevisiae	Allergen Extract-Saccharomyces Cerevisiae Injection Solution	No	Generic	$$$$	No
Allergen Xt-Am.Sycamore Pollen	Allergen Ext-Tree Pollen,American Sycamore Inject. Solution	No	Generic	$$$$	No
All.Xt,Kblue-June Grass Pollen	Allergen Ext,Kentucky Blue-June Grass Pollen Inject Solution	No	Generic	$$$$	No
Allergen Ext-Aspergillus Fumig	Allergenic Extract-Aspergillus Fumigatus Injection Solution	No	Generic	$$$$	No
Allergen Xt-Mite,D.Pteronyssin	Allergenic Ext-Mite, D.Pteronyssinus Injection Solution	No	Generic	$$$$	No
Aller Xt-Tree Pol,E.Cottonwood	Allergen Ext-Tree Pollen,East. Cottonwood Injection Solution	No	Generic	$$$$	No
All Ext-Cal Pepper Tree Pollen	Allergen Ext-Californ.Pepper Tree Pollen Injection Solution	No	Generic	$$$$	No
Aller Ext-Tree Pollen,Am Elm	Allergenic Extract-Tree Pollen,American Elm Injection Soln	No	Generic	$$$$	No
Allergenic Ext, Mixed Feathers	Allergenic Extract, Mixed Feathers Injection Solution	No	Generic	$$$$	No
Aller Ext-Alternaria Alternata	Allergenic Extract-Alternaria Alternata Injection Solution	No	Generic	$$$$	No
Aller Ext-American Cockroach	Allergenic Extract-American Cockroach Injection Solution	No	Generic	$$$$	No
Allergen Ext-Aspergillus,Mixed	Allergenic Extract-Aspergillus,Mixed Injection Solution	No	Generic	$$$$	No
Allerg Ext-Black Walnut Pollen	Allergenic Extract-Black Walnut Tree Pollen Injection Soln	No	Generic	$$$$	No
Allergen Ext-Botrytis Cinerea	Allergenic Extract-Botrytis Cinerea Injection Solution	No	Generic	$$$$	No
Allergen Ext-C.Sphaerospermum	Allergen Extract-Cladospor.Sphaerospermum Injection Solution	No	Generic	$$$$	No
Allergen Ext-Candida Albicans	Allergenic Extract-Candida Albicans Injection Solution	No	Generic	$$$$	No
Allergen Ext-Cattle Epithelium	Allergenic Extract-Cattle Epithelium Injection Solution	No	Generic	$$$$	No
Allergenic Extract-Cockroach	Allergenic Extrct-Cockroach (American,German) Injection Soln	No	Generic	$$$$	No
Allergenic Extract-Corn Smut	Allergenic Extract-Corn Smut Injection Solution	No	Generic	$$$$	No
Allergen Ext-Crop Pollen-Corn	Allergen Extract-Cultivated Crop Pollen-Corn Injection Soln	No	Generic	$$$$	No
Allergenic Extract-Curvularia	Allergenic Extract-Curvularia Injection Solution	No	Generic	$$$$	No
Allergenic Ext-Dog Epithelium	Allergenic Extract-Dog Epithelium Injection Solution	No	Generic	$$$$	No
Allergenic Xt-Epicoccum Nigrum	Allergenic Extract-Epicoccum Nigrum Injection Solution	No	Generic	$$$$	No
Allergenic Extract-Fire Ant	Allergenic Extract-Fire Ant Injection Solution	No	Generic	$$$$	No
Allergen Ext-German Cockroach	Allergenic Extract-German Cockroach Injection Solution	No	Generic	$$$$	No
Allergenic Ext-Grass Pollen	Allergenic Extract-Grass Pollen Injection Solution	No	Generic	$$$$	No
Allergen Xt-Grass Pollen-Bahia	Allergenic Extract-Grass Pollen-Bahia Injection Solution	No	Generic	$$$$	No
Allerg Ex-Grass Pollen-Johnson	Allergenic Extract-Grass Pollen-Johnson Injection Solution	No	Generic	$$$$	No
Allergen Xt-Grass Pollen-Brome	Allergenic Extract-Grass Pollen-Smooth Brome Injection Soln	No	Generic	$$$$	No
Allergenic Ex-Horse Epithelium	Allergenic Extract-Horse Epithelium Injection Solution	No	Generic	$$$$	No
Allergenic Ext-Mite, D Farinae	Allergenic Extract-Mite,D.Farinae Injection Solution	No	Generic	$$$$	No
Allergenic Extract-Mosquito	Allergenic Extract-Mosquito Injection Solution	No	Generic	$$$$	No
Allergenic Xt-Mouse Epithelium	Allergenic Extract-Mouse Epithelium Injection Solution	No	Generic	$$$$	No
Allergenic Ext-Mucor Plumbeus	Allergenic Extract-Mucor Plumbeus Injection Solution	No	Generic	$$$$	No
Allergen Ext-Olive Tree Pollen	Allergenic Extract-Olive Tree Pollen Injection Solution	No	Generic	$$$$	No
Allerg Ext-Penicillium Notatum	Allergenic Extract-Penicillium Notatum Injection Solution	No	Generic	$$$$	No
Allergenic Ext-Phoma Herbarum	Allergenic Extract-Phoma Herbarum Injection Solution	No	Generic	$$$$	No
Allergen Xt-Grass Pollen-Quack	Allergenic Extract-Quack Grass Pollen Injection Solution	No	Generic	$$$$	No
Allergen Xt-Queen Palm Pollen	Allergenic Extract-Queen Palm Pollen Injection Solution	No	Generic	$$$$	No
Allergen Ext-Rabbit Epithelium	Allergenic Extract-Rabbit Epithelium Injection Solution	No	Generic	$$$$	No
Allergenic Ext-Rhizopus Oryzae	Allergenic Extract-Rhizopus Oryzae Injection Solution	No	Generic	$$$$	No
Aller Xt-Shagbark Hickory Poll	Allergenic Ext-Shagbark Hickory Tree Pollen Injection Soln	No	Generic	$$$$	No
Allergenic Ext-Tree Pollen	Allergenic Extract-Tree And Shrub Pollen Injection Solution	No	Generic	$$$$	No
Aller Ext-Tree Pollen,Bayberry	Allergenic Extract-Tree Pollen, Bayberry Injection Solution	No	Generic	$$$$	No
Aller Xt-Tree Pollen,Hackberry	Allergenic Extract-Tree Pollen, Hackberry Injection Solution	No	Generic	$$$$	No
Aller Ext-Tree Pollen,Mesquite	Allergenic Extract-Tree Pollen, Mesquite Injection Solution	No	Generic	$$$$	No
Allergen Ext-Tree Pollen,Pecan	Allergenic Extract-Tree Pollen, Pecan Injection Solution	No	Generic	$$$$	No
Aller Xt-Tree Pollen,Red Birch	Allergenic Extract-Tree Pollen, Red Birch Injection Solution	No	Generic	$$$$	No
Aller Ext-Tree Poll,Red Cedar	Allergenic Extract-Tree Pollen, Red Cedar Injection Solution	No	Generic	$$$$	No
Aller Xt-Tree Pollen,White Ash	Allergenic Extract-Tree Pollen, White Ash Injection Solution	No	Generic	$$$$	No
Aller Xt-Tree Pollen-White Oak	Allergenic Extract-Tree Pollen, White Oak Injection Solution	No	Generic	$$$$	No
Aller Xt-Tree Pollen,Box Elder	Allergenic Extract-Tree Pollen,Box Elder Injection Solution	No	Generic	$$$$	No
Allerg Ext-Tree Pollen-Acacia	Allergenic Extract-Tree Pollen-Acacia Injection Solution	No	Generic	$$$$	No
Allerg Ext-Tree Pollen-Alder	Allergenic Extract-Tree Pollen-Alder White Injection Soln	No	Generic	$$$$	No
Allergen Ext-Amer Beech Pollen	Allergenic Extract-Tree Pollen-American Beech Injection Soln	No	Generic	$$$$	No
Tree Pollen-Bald Cypress	Allergenic Extract-Tree Pollen-Bald Cypress Injection Soln	No	Generic	$$$$	No
Tree Pollen-Black Willow	Allergenic Extract-Tree Pollen-Black Willow Injection Soln	No	Generic	$$$$	No
Allerg Xt-Tree Poll-Elm, Cedar	Allergenic Extract-Tree Poll-Elm, Cedar Injection Solution	No	Generic	$$$$	No
Allerg Ext-Tree Poll-Jun, West	Allerg Ext-Tree Poll-Jun, West Injection Solution	No	Generic	$$$$	No
Allergen Ext-Tree Pollen-Kapok	Allergenic Extract-Tree Pollen-Kapok Injection Solution	No	Generic	$$$$	No
Aller Xt-Tree Pollen-Melaleuca	Allergenic Extract-Tree Pollen-Melaleuca Injection Solution	No	Generic	$$$$	No
Allergn Xt-Red Mulberry Pollen	Allergenic Extract-Red Mulberry Pollen Injection Solution	No	Generic	$$$$	No
Allerg Xt-White Pine Pollen	Allergenic Extract-White Pine Tree Pollen Injection Solution	No	Generic	$$$$	No
Tree Pollen-Privet	Allergenic Extract-Tree Pollen-Privet Injection Solution	No	Generic	$$$$	No
Allerg Ext-Tree Poll-Red Maple	Allergenic Extract-Tree Pollen-Red Maple Injection Solution	No	Generic	$$$$	No
Allerg Ext-Tree Pollen-Red Oak	Allergenic Extract-Tree Pollen-Red Oak Injection Solution	No	Generic	$$$$	No
Tree Pollen-Sweet Gum	Allergenic Extract-Tree Pollen-Sweet Gum Injection Solution	No	Generic	$$$$	No
Allergen Xt-Virginia Live Oak	Allergenic Extract-Tree Pollen,Virginia Live Oak Inject Soln	No	Generic	$$$$	No
Allerg Xt-White Birch Pollen	Allergenic Extract-Tree Pollen-White Birch Injection Soln	No	Generic	$$$$	No
Allergn Xt-Wht Mulberry Pollen	Allergenic Ext-Tree Pollen-White Mulberry Injection Solution	No	Generic	$$$$	No
Weed Pollen-True Marsh Elder	Allergenic Extract-True Marsh Elder Pollen Injection Soln	No	Generic	$$$$	No
Weed Pollen-Carelessweed	Allergenic Extract-Weed Pollen-Carelessweed Injection Soln	No	Generic	$$$$	No
Aller Xt-Weed Pollen-Cocklebur	Allergen Extract-Weed Pollen-Cocklebur Injection Solution	No	Generic	$$$$	No
Allerg Xt-Weed Poll-Dog Fennel	Allergenic Extract-Weed Pollen-Dog Fennel Injection Solution	No	Generic	$$$$	No
Aller Xt-Weed Pollen-Goldenrod	Allergenic Extract-Weed Pollen-Goldenrod Injection Solution	No	Generic	$$$$	No
Aller Ext-Weed Pollen-Kochia	Allergenic Ext-Weed Pollen-Kochia(Firebush) Injection Soln	No	Generic	$$$$	No
Allergen-Weed-Lambsquarters	Allergen Extrct-Weed Pollen-Lambsquarters Injection Solution	No	Generic	$$$$	No
Allerg Ext-Weed Pollen-Mugwort	Allergenic Extract-Weed Pollen-Mugwort Injection Solution	No	Generic	$$$$	No
Allerg Ex-Weed Pol-Rgh Pigweed	Allergenic Extract-Weed Pollen-Rough Pigweed Injection Soln	No	Generic	$$$$	No
All Xt-Weed Pol-Russian Thistl	Allergenic Extract-Weed Pollen-Russian Thistle Inject. Soln	No	Generic	$$$$	No
Aller Xt-Weed Pollen-Sagebrush	Allergenic Extract-Weed Pollen-Sagebrush Injection Solution	No	Generic	$$$$	No
All Ext-Weed Pol-Sheep Sorrel	Allergenic Extract-Weed Pollen-Sheep Sorrel Injection Soln	No	Generic	$$$$	No
Weed Pollen-Short Ragweed	Allergenic Ext-Weed Pollen-Short Ragweed Injection Soln	No	Generic	$$$$	No
Aller Ext-Spiny Pigweed Pollen	Allergenic Extract-Weed Pollen-Spiny Pigweed Injection Soln	No	Generic	$$$$	No
Allerg Ext-Tall Ragweed Pollen	Allergenic Extract-Weed Pollen-Tall Ragweed Injection Soln	No	Generic	$$$$	No
Aller Xt-Weed Poll-Yellow Dock	Allergenic Extrct-Weed Pollen-Yellow Dock Injection Solution	No	Generic	$$$$	No
Tree Pollen-Arizona Cypress	Allergenic Extrct-Tree Pollen-Arizona Cypress Injection Soln	No	Generic	$$$$	No
Allergen Xt Tree Pol-Aust Pine	Allergenic Extrct-Tree Pollen-Australian Pine Injection Soln	No	Generic	$$$$	No
Allerg Ext-Grass,Perennial Rye	Allergenic Ext-Grass Pollen,Perennial Rye Injection Soln	No	Generic	$$$$	No
Aspergillus Fumigatus	Aspergillus Fumigatus Subcutaneous Solution	No	Brand	$$$$	No
Cat Hair Std Allergenic Ext	Cat Hair Std Allergenic Extract Injection Solution	No	Generic	$$$$	No
Std Grass Pollen-Sweet Vernal	Standard Grass Pollen-Sweet Vernal Injection Solution	No	Generic	$$$$	No

Alternative Drug Information

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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.

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	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
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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 Allergen Ext,Kentucky Blue-June Grass Pollen Inject Solution.

Alternative drugs to All.Xt,Kblue-June Grass Pollen may be available. Review this list with your doctor.

These alternative drugs are not covered.