NAMZARIC 28/10 mg Capsule
Also known as Memantine Hydrochloride And Donepezil Hydrochloride. 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 3–4.
No plan applies a prior authorization, step therapy or quantity limit.
79 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: 67 plans · WV: 12 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.9683 | — | None |
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $20.3360 | — | 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.