NAMZARIC 21/10 mg Capsule
Also known as Memantine Hydrochloride And Donepezil Hydrochloride. Coverage in Hawaii (CMS PDP Region 33).
2 of 8 stand-alone Part D plans in Hawaii cover this drug on tier 3–4.
No plan applies a prior authorization, step therapy or quantity limit.
1 Medicare Advantage plan in HI 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. HI: 1 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $19.7432 | — | None |
| SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $21.4980 | — | None |
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.