CYCLOSPORINE MODIFIED 50 mg Capsule, Liquid Filled
Also known as Cyclosporine. Coverage in Indiana and Kentucky (CMS PDP Region 15).
10 of 10 stand-alone Part D plans in Indiana and Kentucky cover this drug on tier 4.
10 of 10 plans apply a prior authorization, step therapy or quantity limit.
Every plan that covers it
Showing 10 of 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 33% | — | $1.4145 | — |
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| Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.2789 | — |
|
| Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 27% | 27% | $1.2789 | — |
|
| Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $1.4289 | — |
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| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 35% | 35% | $1.8074 | — |
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| HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.1095 | — |
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| AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 42% | — | $1.2437 | — |
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| HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.1366 | — |
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| Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1.4064 | — |
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| AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible | 4Non-Preferred Drug | 34% | — | $1.2301 | — |
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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.
Medicare Advantage plans
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D, and are sold county by county. Pick a county to see every Medicare Advantage drug plan there that covers this drug.
219 Medicare Advantage plans in IN, KY do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. IN: 116 plans · KY: 103 plans.