FLUTICASONE PROPIONATE AND SALMETEROL 113/14 ug Powder, Metered
Coverage in New Jersey (CMS PDP Region 04).
2 of 12 stand-alone Part D plans in New Jersey cover this drug on tier 3.
2 of 2 plans apply a prior authorization, step therapy or quantity limit.
12 Medicare Advantage plans in NJ 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. NJ: 12 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $216.3916 | $216.391 unit |
|
| Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible | 3Preferred Brand | 20% | 20% | $216.3916 | $216.391 unit |
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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.