BLUJEPA 750 mg Tablet, Film Coated
Also known as Gepotidacin. Coverage in Pennsylvania and West Virginia (CMS PDP Region 06).
5 of 12 stand-alone Part D plans in Pennsylvania and West Virginia cover this drug on tier 3–5.
3 of 5 plans apply a prior authorization, step therapy or quantity limit.
183 Medicare Advantage plans in PA, WV 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. PA: 158 plans · WV: 25 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $98.8215 | $1,185.8612 units |
|
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 4Non-Preferred Drug | 25% | 25% | $90.4204 | $1,085.0412 units |
|
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 25% | 25% | $90.9938 | $1,091.9312 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $98.8382 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $98.8382 | — | None |
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.