OLMESARTAN MEDOXOMIL, AMLODIPINE AND HYDROCHLOROTHIAZIDE 40/5/25 mg Tablet, Film Coated
Coverage in New Jersey (CMS PDP Region 04).
5 of 12 stand-alone Part D plans in New Jersey cover this drug on tier 1–4.
Lowest 30-day cost $0.00 at a preferred pharmacy. 5 of 5 plans apply a prior authorization, step therapy or quantity limit.
72 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: 72 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)$22.80/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.7080 | $2.123 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.9179 | $2.753 units |
|
| Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible | 3Preferred Brand | 20% | 20% | $1.5340 | $4.603 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.1737 | $3.523 units |
|
| Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $4.3955 | $13.193 units |
|
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.