CLINIMIX 311/238/247/170/255/247/204/179/77/880/438/489/289/213/17/10 mg/100mL/g/100mL Injection
Also known as Leucine, Phenylalanine, Lysine, Methionine, Isoleucine, Valine, Histidine, Threonine, Tryptophan, Alanine, Glycine, Arginine, Proline, Serine, Tyrosine, Dextrose. Coverage in Pennsylvania and West Virginia (CMS PDP Region 06).
8 of 12 stand-alone Part D plans in Pennsylvania and West Virginia cover this drug on tier 4.
8 of 8 plans apply a prior authorization, step therapy or quantity limit.
Every plan that covers it
Showing 8 of 8 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$6.60/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 33% | — | $0.0377 | — |
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| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 4Non-Preferred Drug | 33% | — | $0.0377 | — |
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| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 35% | 35% | $0.0406 | — |
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| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $0.0458 | — |
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| HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $0.0458 | — |
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| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $0.0377 | — |
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| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 4Non-Preferred Drug | 25% | 25% | $0.0457 | — |
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| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 25% | 25% | $0.0462 | — |
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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.
267 Medicare Advantage plans in PA, WV do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. PA: 216 plans · WV: 51 plans.