BREZTRI 160/9/4.8 ug Aerosol, Metered

Also known as Budesonide, Glycopyrrolate, And Formoterol Fumarate. Coverage in Alaska (CMS PDP Region 34).

7 of 9 stand-alone Part D plans in Alaska cover this drug on tier 3.

Lowest 30-day cost $45.00 at a preferred pharmacy. 7 of 7 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%	$60.3390	$663.7311 units	Quantity limit 10.7 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible	3Preferred Brand	24%	19%	$61.5654	$677.2211 units	Quantity limit 10.7 per 30 days
Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible	3Preferred Brand	20%	15%	$61.5654	$677.2211 units	Quantity limit 10.7 per 30 days
Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible	3Preferred Brand	25%	25%	$60.3390	$663.7311 units	Quantity limit 10.7 per 30 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible	3Preferred Brand	18%	18%	$63.1531	$694.6811 units	Quantity limit 10.7 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible	3Preferred Brand	18%	18%	$65.3142	$718.4611 units	Quantity limit 10.7 per 30 days
Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible	3Preferred Brand	$45.00	$125.00	$61.5654	$677.2211 units	Quantity limit 10.7 per 30 days

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.

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