PLENAMINE 1.18/1.04/1.04/960/749/749/749/250/2.17/1.47/1.04/894/894/749/592/434/39 g/100mL/mg/100mL Solution
Also known as Lysine Acetate, Leucine, Phenylalanine, Valine, Isoleucine, Methionine, Threonine, Tryptophan, Alanine, Arginine, Glycine, Histidine, Proline, Glutamic Acid, Serine, Aspartic Acid, And Tyrosine. Coverage in Pennsylvania and West Virginia (CMS PDP Region 06).
10 of 12 stand-alone Part D plans in Pennsylvania and West Virginia cover this drug on tier 3–4.
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 |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.0495 | — |
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| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 28% | 28% | $0.0495 | — |
|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 35% | 35% | $0.0621 | — |
|
| AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 41% | — | $0.0421 | — |
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| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $0.0496 | — |
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| HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $0.0497 | — |
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| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 4Non-Preferred Drug | 33% | — | $0.0421 | — |
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| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $0.0403 | — |
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| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 3Preferred Brand | 25% | 25% | $0.0494 | — |
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| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $0.0494 | — |
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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.
306 Medicare Advantage plans in PA, WV do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. PA: 248 plans · WV: 58 plans.