RYBELSUS 14 mg Tablet
Also known as Oral Semaglutide. Coverage in Wisconsin (CMS PDP Region 16).
7 of 10 stand-alone Part D plans in Wisconsin 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.
77 Medicare Advantage plans in WI 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. WI: 77 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $31.8017 | $95.413 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $32.7720 | $98.323 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $35.3635 | $106.093 units |
|
| SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $33.3313 | $99.993 units |
|
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $32.7403 | $98.223 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $35.3635 | $106.093 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 6Select Care Drugs | $11.00 | $33.00 | $31.8017 | $95.413 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.