SODIUM OXYBATE .5 g/mL Solution

Coverage in Arkansas (CMS PDP Region 19).

10 of 12 stand-alone Part D plans in Arkansas cover this drug on tier 5.

10 of 10 plans apply a prior authorization, step therapy or quantity limit.

67 Medicare Advantage plans in AR do cover it

Medicare Advantage plans carry their own formularies, separate from stand-alone Part D. A patient on an MA-PD plan may have coverage even where no PDP lists the drug. AR: 67 plans.

Every plan that covers it

Plan	Tier	30-day preferred	90-day mail	Unit cost	Est. 30-day fill	Restrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$25.1425	$1,357.6954 units	Prior authorization Quantity limit 54 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$25.1425	$1,357.6954 units	Prior authorization Quantity limit 54 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$24.7913	$1,338.7354 units	Prior authorization Quantity limit 54 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$35.7680	$1,931.4754 units	Prior authorization Quantity limit 54 per 30 days
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible	5Specialty Tier	26%	—	$35.7680	$1,931.4754 units	Prior authorization Quantity limit 54 per 30 days
BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$28.4875	$1,538.3354 units	Prior authorization Quantity limit 54 per 30 days
HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$24.7913	$1,338.7354 units	Prior authorization Quantity limit 54 per 30 days
SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$35.1799	$1,899.7154 units	Prior authorization Quantity limit 54 per 30 days
Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible	5Specialty Tier	33%	—	$35.7680	$1,931.4754 units	Prior authorization Quantity limit 54 per 30 days
BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible	5Specialty Tier	33%	—	$28.4875	$1,538.3354 units	Prior authorization Quantity limit 54 per 30 days

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.

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