RYBELSUS 3 mg Tablet
Also known as Oral Semaglutide. Coverage in Louisiana (CMS PDP Region 21).
7 of 10 stand-alone Part D plans in Louisiana cover this drug on tier 3–6.
Lowest 30-day cost $11.00 at a preferred pharmacy. 7 of 7 plans apply a prior authorization, step therapy or quantity limit.
103 Medicare Advantage plans in LA 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. LA: 103 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $31.4023 | $94.213 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $35.2841 | $105.853 units |
|
| SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $33.3100 | $99.933 units |
|
| HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $32.4541 | $97.363 units |
|
| HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $32.4467 | $97.343 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $35.2841 | $105.853 units |
|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 6Select Care Drugs | $11.00 | $33.00 | $31.4023 | $94.213 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.