BREZTRI 160/9/4.8 ug Aerosol, Metered
Also known as Budesonide, Glycopyrrolate, And Formoterol Fumarate. Coverage in New York (CMS PDP Region 03).
7 of 10 stand-alone Part D plans in New York 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.
185 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: 185 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% | $57.9930 | $637.9211 units |
|
| Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $57.9930 | $637.9211 units |
|
| SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $62.9631 | $692.5911 units |
|
| Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $60.9500 | $670.4511 units |
|
| Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible | 3Preferred Brand | 17% | 12% | $60.9500 | $670.4511 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $64.8743 | $713.6211 units |
|
| Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $60.9500 | $670.4511 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.