BREZTRI 160/9/4.8 ug Aerosol, Metered
Also known as Budesonide, Glycopyrrolate, And Formoterol Fumarate. Coverage in North Carolina (CMS PDP Region 08).
9 of 12 stand-alone Part D plans in North Carolina cover this drug on tier 3.
Lowest 30-day cost $45.00 at a preferred pharmacy. 9 of 9 plans apply a prior authorization, step therapy or quantity limit.
127 Medicare Advantage plans in NC 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. NC: 127 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)$3.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $58.8156 | $646.9711 units |
|
| Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $58.8156 | $646.9711 units |
|
| Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $61.3165 | $674.4811 units |
|
| Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $61.3165 | $674.4811 units |
|
| Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $65.7282 | $723.0111 units |
|
| SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $62.9519 | $692.4711 units |
|
| Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $61.3165 | $674.4811 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $65.5782 | $721.3611 units |
|
| Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $135.00 | $65.7282 | $723.0111 units |
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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.