PAXLOVID Kit

Also known as Nirmatrelvir And Ritonavir. Coverage in New York (CMS PDP Region 03).

10 of 10 stand-alone Part D plans in New York cover this drug on tier 2–5.

Lowest 30-day cost $6.00 at a preferred pharmacy. 10 of 10 plans apply a prior authorization, step therapy or quantity limit.

192 Medicare Advantage plans in NY 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. NY: 192 plans.

Every plan that covers it

Plan	Tier	30-day preferred	90-day mail	Unit cost	Est. 30-day fill	Restrictions
SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible	2Generic	$6.00	$18.00	$50.5492	$50.551 unit	Quantity limit 6 per 180 days
Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible	3Preferred Brand	25%	25%	$46.9851	$46.991 unit	Quantity limit 3 per 90 days
Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible	3Preferred Brand	25%	25%	$46.9851	$46.991 unit	Quantity limit 3 per 90 days
Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible	3Preferred Brand	25%	20%	$49.5361	$891.6518 units	Quantity limit 6 per 10 days
Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible	3Preferred Brand	17%	12%	$49.5361	$891.6518 units	Quantity limit 6 per 10 days
Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible	3Preferred Brand	$45.00	$125.00	$49.5361	$891.6518 units	Quantity limit 6 per 10 days
HealthSpring Assurance Rx (PDP)$35.70/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$48.7453	$48.751 unit	Quantity limit 3 per 90 days
HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$48.7682	$48.771 unit	Quantity limit 3 per 90 days
AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$52.2911	$941.2418 units	Quantity limit 3 per 5 days
AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible	5Specialty Tier	31%	—	$52.2911	$941.2418 units	Quantity limit 3 per 5 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.

See coverage in all 39 regions →