2024 Medicare Part D Plan’s Negotiated Retail Drug Price
| 2024 Medicare Prescription Drug Price Information | ||||||
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Asuris Medicare Script Enhanced (PDP) (S5609-002-0) Benefits & Contact Info  
Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less. | ||||||
Click on a letter below to view the Asuris Medicare Script Enhanced (PDP) Formulary A B C D E F G H I J K L M N O P Q R S T U V W X Y Z 0-9 | ||||||
ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [Zovirax Suspension]  | ||||||
| Plan’s average negotiated retail drug price in CMS PDP Region 30, includes: OR WA | $28.60* 30-Day Supply $59.76* 90-Day Supply | |||||
| Formulary (Drug List) drug tier: | Tier #4: Non-Preferred Drug | |||||
| Does this plan offer any Gap coverage? | Yes | |||||
| Does this drug have Gap coverage? | No, this drug IS NOT covered in the gap, but all drugs receive the donut hole discount. | |||||
| Drug Usage Management Restrictions: | None | |||||
| Formulary (Drug List) Tier Cost-Sharing Details | ||||||
| Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less. | ||||||
| 30-Day Supply Cost-Sharing |
90-Day Supply Cost-Sharing |
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| Preferred Pharmacy | Standard Pharmacy | Mail- Order** | Preferred Pharmacy | Standard Pharmacy | Mail- Order** | |
| This plan does not have an Initial Deductible: | ||||||
| n/a | n/a | n/a | n/a | n/a | n/a | |
| Initial Coverage Phase Cost-Sharing: | ||||||
| 40% | 40% | 40% | 40% | 40% | 40% | |
| Coverage Gap Phase Cost-Sharing Incl. Donut Hole Discount (Generics 75%): | ||||||
| 25% | 25% | 25% | 25% | 25% | 25% | |
| Coverage Gap Phase Cost-Sharing Incl. Donut Hole Discount (Brand 75%): | ||||||
| 25% | 25% | 25% | 25% | 25% | 25% | |
| Catastrophic Coverage Phase Cost-Sharing (all Formulary Drugs): | ||||||
| $0 | $0 | $0 | $0 | $0 | $0 | |
| Your Estimated Cost for Purchases During Each Coverage Phase | ||||||
| 30-Day Supply Cost-Sharing |
90-Day Supply Cost-Sharing |
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| Preferred Pharmacy | Standard Pharmacy | Mail- Order** | Preferred Pharmacy | Standard Pharmacy | Mail- Order** | |
| Your Estimated Cost Initial Coverage Phase: | ||||||
| $11.44 | $11.44 | $11.44 | $23.90 | $23.90 | $23.90 | |
| Your Estimated Cost in Gap if Drug is Generic (75% discount): | ||||||
| $7.15 | $7.15 | $7.15 | $14.94 | $14.94 | $14.94 | |
| Your Estimated Cost in Gap if Drug is Brand-Name (75% discount): | ||||||
| $7.15 | $7.15 | $7.15 | $14.94 | $14.94 | $14.94 | |
| Your Estimated Cost in Catastrophic Coverage (all Formulary Drugs): | ||||||
| $0 | $0 | $0 | $0 | $0 | $0 | |
| Tier Cost-Sharing Details and Your Costs with Explanations | ||||||
| 30-Day Supply Cost-Sharing |
90-Day Supply Cost-Sharing |
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| Preferred Pharmacy | Standard Pharmacy | Mail- Order** | Preferred Pharmacy | Standard Pharmacy | Mail- Order** | |
| --- If you purchase during the Initial Deductible Phase --- | ||||||
| This plan does not have an Initial Deductible: | ||||||
| n/a | n/a | n/a | n/a | n/a | n/a | |
| --- If you purchase during the Initial Coverage Phase --- | ||||||
| Initial Coverage Phase Cost-Sharing: | ||||||
| 40% | 40% | 40% | 40% | 40% | 40% | |
| Your Estimated Cost Initial Coverage Phase: | ||||||
| $11.44 | $11.44 | $11.44 | $23.90 | $23.90 | $23.90 | |
| Explanation for 30-Day Preferred Pharmacy purchase: | ||||||
| The cost-sharing for purchases made during the initial coverage phase (ICP) would be $11.44 or ($28.60 x 40%). | ||||||
| --- If you purchase during the Coverage Gap Phase (Donut Hole) --- | ||||||
| Your Estimated Cost in Gap if Drug is Generic (75% discount): | ||||||
| $7.15 | $7.15 | $7.15 | $14.94 | $14.94 | $14.94 | |
| Explanation for 30-Day Preferred Pharmacy purchase: | ||||||
| Your cost is the negotiated retail price of $28.60 x 25%. | ||||||
| Your Estimated Cost in Gap if Drug is Brand-Name (75% discount): | ||||||
| $7.15 | $7.15 | $7.15 | $14.94 | $14.94 | $14.94 | |
| Explanation for 30-Day Preferred Pharmacy purchase: | ||||||
| Your costs is the negotiated retail price of $28.60 x 25%. | ||||||
| --- If you purchase during the Catastrophic Coverage Phase --- | ||||||
| Catastrophic Coverage Phase Cost-Sharing (all Formulary Drugs): | ||||||
| $0 | $0 | $0 | $0 | $0 | $0 | |
| Your Estimated Cost in Catastrophic Coverage (all Formulary Drugs): | ||||||
| $0 | $0 | $0 | $0 | $0 | $0 | |
| Explanation for 30-Day Preferred Pharmacy purchase: | ||||||
| Beginning with plan year 2024, the Inflation Reduction Act (IRA) of 2022 eliminates beneficiary cost-sharing once your TrOOP reaches $8,000 -- the established maximum cap on out-of-pocket spending for Part D formulary drugs (RxMOOP). | ||||||
| Asuris Medicare Script Enhanced (PDP) Average Negotiated Retail Drug Price History | ||||||
| 30-Day Supply | 90 Day Supply | |||||
| March, 2024: | $28.60 | $59.76 | ||||
| January, 2024: | $29.22 | $62.13 | ||||
| September, 2023: | $46.70 | $106.02 | ||||
| June, 2023: | $48.00 | $111.00 | ||||
| March, 2023: | $59.00 | $177.00 | ||||
| January, 2023: | $57.00 | $171.00 | ||||
| September, 2022: | n/a | n/a | ||||
| June, 2022: | n/a | n/a | ||||
| March, 2022: | n/a | n/a | ||||
| January, 2022: | n/a | n/a | ||||
| September, 2021: | n/a | n/a | ||||
| June, 2021: | n/a | n/a | ||||
| March, 2021: | n/a | n/a | ||||
| January, 2021: | n/a | n/a | ||||
| September, 2020: | n/a | n/a | ||||
| June, 2020: | n/a | n/a | ||||
| March, 2020: | n/a | n/a | ||||
| January, 2020: | n/a | n/a | ||||
| September, 2019: | ||||||
| June, 2019: | ||||||
| March, 2019: | ||||||
| January, 2019: | ||||||
| September, 2018: | ||||||
| June, 2018: | ||||||
| March, 2018: | ||||||
| January, 2018: | ||||||
| September, 2017: | ||||||
| June, 2017: | ||||||
| March, 2017: | ||||||
| January, 2017: | ||||||
| September, 2016: | ||||||
| June, 2016: | ||||||
| April, 2016: | ||||||
| January, 2016: | ||||||
| September, 2015: | ||||||
| June, 2015: | ||||||
| April, 2015: | ||||||
| January, 2015: | ||||||
| September, 2014: | ||||||
| June, 2014: | ||||||
| March, 2014: | ||||||
| January, 2014: | ||||||
| October, 2013: | ||||||
| January, 2013: | -- | |||||
| April, 2012: | -- | |||||
| September, 2010: | -- | |||||
| Notes:
*The Medicare drug plan’s average negotiated retail drug price is based on several variables: the medication, the quantity of your prescription, the specific Medicare Part D plan, and the pharmacies in the plan’s service area. In this case, the average of the ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [Zovirax Suspension] prices that the Asuris Medicare Script Enhanced (PDP) has negotiated with each of the retail pharmacies in the plan’s service area (CMS PDP Region 30, includes: OR WA). In other words, when you use the Asuris Medicare Script Enhanced (PDP) to purchase ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [Zovirax Suspension], you may pay slightly more or slightly less than the figures shown in the table above depending on the pharmacy where you fill your prescription and the quantity of your prescription. The example average retail prices used above are based on a quantity of 100 for the 30-day supply and a quantity of 300 for the 90-day supply. **The mail-order cost-sharing is the plan’s "preferred" mail-order cost-sharing. |
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| Return to the Asuris Medicare Script Enhanced (PDP) 2024 Formulary Browser by choosing a letter below: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z 0-9 | ||||||