HYDROCODONE BITARTRATE AND ACETAMINOPHEN 10/300 mg Tablet
Coverage in Pennsylvania and West Virginia (CMS PDP Region 06).
2 of 12 stand-alone Part D plans in Pennsylvania and West Virginia cover this drug on tier 3.
2 of 2 plans apply a prior authorization, step therapy or quantity limit.
94 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: 85 plans · WV: 9 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% | $0.5539 | $9.9718 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $0.4054 | $7.3018 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.