LOKELMA 10 g/10g Powder, For Suspension
Also known as Sodium Zirconium Cyclosilicate. Coverage in New York (CMS PDP Region 03).
8 of 10 stand-alone Part D plans in New York cover this drug on tier 3–4.
Lowest 30-day cost $45.00 at a preferred pharmacy. 6 of 8 plans apply a prior authorization, step therapy or quantity limit.
192 Medicare Advantage plans in NY 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. NY: 192 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $26.6787 | — | None |
| Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $26.6787 | — | None |
| SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $29.8080 | $1,013.4734 units |
|
| Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $28.1044 | $84.313 units |
|
| Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible | 3Preferred Brand | 17% | 12% | $28.1044 | $84.313 units |
|
| Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $28.1044 | $84.313 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 38% | — | $29.8692 | $268.829 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible | 4Non-Preferred Drug | 28% | — | $29.8692 | $268.829 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.