TRAVASOL 730/560/580/400/600/580/480/420/180/2.07/1.03/1.15/680/40/500 mg/100mL/g/100mL Injection
Also known as Leucine, Phenylalanine, Lysine Hydrochloride, Methionine, Isoleucine, Valine, Histidine, Threonine, Tryptophan, Alanine, Glycine, Arginine, Proline, Tyrosine, Serine. Coverage in Arizona (CMS PDP Region 28).
10 of 10 stand-alone Part D plans in Arizona cover this drug on tier 4.
10 of 10 plans apply a prior authorization, step therapy or quantity limit.
Every plan that covers it
Showing 10 of 10 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 32% | 32% | $0.0289 | — |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 40% | 40% | $0.0289 | — |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 29% | 29% | $0.0285 | — |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 30% | — | $0.0285 | — |
|
| Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $0.0285 | — |
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| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 36% | — | $0.0298 | — |
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| HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $0.0285 | — |
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| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.0425 | — |
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| AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible | 4Non-Preferred Drug | 35% | — | $0.0298 | — |
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| Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $0.0285 | — |
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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.
Medicare Advantage plans
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D, and are sold county by county. Pick a county to see every Medicare Advantage drug plan there that covers this drug.
117 Medicare Advantage plans in AZ do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. AZ: 117 plans.