NYSTOP 100000 [USP'U]/g Powder
Also known as Nystatin. Coverage in Missouri (CMS PDP Region 18).
10 of 10 stand-alone Part D plans in Missouri cover this drug on tier 2–4.
Lowest 30-day cost $8.00 at a preferred pharmacy. 7 of 10 plans apply a prior authorization, step therapy or quantity limit.
141 Medicare Advantage plans in MO 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. MO: 141 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Saver from UHC (PDP)$71.90/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $0.2360 | $2.8312 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.3142 | $3.7712 units |
|
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.8491 | $15.2818 units |
|
| HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $0.5262 | $9.4718 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3464 | $2.086 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.1526 | $1.8312 units |
|
| Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 26% | 26% | $0.7744 | $9.2912 units |
|
| Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | — | $0.4808 | — | None |
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $0.4839 | — | None |
| Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $0.4791 | — | 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.