XIGDUO XR 5/500 mg Tablet, Film Coated, Extended Release
Also known as Dapagliflozin And Metformin Hydrochloride. Coverage in Nevada (CMS PDP Region 29).
7 of 10 stand-alone Part D plans in Nevada cover this drug on tier 3.
7 of 7 plans apply a prior authorization, step therapy or quantity limit.
92 Medicare Advantage plans in NV 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. NV: 92 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5849 | $111.516 units |
|
| Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5849 | $111.516 units |
|
| HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.9835 | $113.906 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$76.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $20.3795 | $61.143 units |
|
| HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $19.0382 | $114.236 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4309 | $116.596 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $20.3795 | $61.143 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.