BEVESPI AEROSPHERE 9/4.8 ug Aerosol, Metered
Also known as Glycopyrrolate And Formoterol Fumarate. Coverage in Alaska (CMS PDP Region 34).
2 of 9 stand-alone Part D plans in Alaska cover this drug on tier 3.
2 of 2 plans apply a prior authorization, step therapy or quantity limit.
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% | $40.4858 | $445.3411 units |
|
| Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $40.4858 | $445.3411 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.