BUTALBITAL, ACETAMINOPHEN, AND CAFFEINE 50/325/40 mg Tablet
Coverage in Hawaii (CMS PDP Region 33).
5 of 8 stand-alone Part D plans in Hawaii cover this drug on tier 3–4.
5 of 5 plans apply a prior authorization, step therapy or quantity limit.
Every plan that covers it
Showing 5 of 5 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 38% | — | $0.1890 | $3.4018 units |
|
| Humana Basic Rx Plan (PDP)$0.40/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 28% | — | $0.3458 | $6.2218 units |
|
| Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible | 4Non-Preferred Drug | 30% | — | $0.3501 | $6.3018 units |
|
| Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $0.3458 | $6.2218 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $0.1890 | $3.4018 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.
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.
18 Medicare Advantage plans in HI do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. HI: 18 plans.