NYVEPRIA 6 mg/.6mL Injection, Solution
Also known as Pegfilgrastim-Apgf. Coverage in Delaware, DC and Maryland (CMS PDP Region 05).
4 of 10 stand-alone Part D plans in Delaware, DC and Maryland cover this drug on tier 5.
4 of 4 plans apply a prior authorization, step therapy or quantity limit.
23 Medicare Advantage plans in DE, DC, MD 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. DE: 6 plans · DC: 2 plans · MD: 15 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $5815.9629 | — |
|
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $5815.9629 | — |
|
| HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $5828.2543 | — |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $5828.9720 | — |
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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.