BUDESONIDE AND FORMOTEROL FUMARATE DIHYDRATE 160/4.5 ug Aerosol
Coverage in Pennsylvania and West Virginia (CMS PDP Region 06).
3 of 12 stand-alone Part D plans in Pennsylvania and West Virginia cover this drug on tier 3.
3 of 3 plans apply a prior authorization, step therapy or quantity limit.
281 Medicare Advantage plans in PA, WV 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. PA: 245 plans · WV: 36 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $14.8051 | $148.0510 units |
|
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 3Preferred Brand | 25% | 25% | $21.7650 | $217.6510 units |
|
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $21.7895 | $217.9010 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.