MEMANTINE HYDROCHLORIDE Kit

Coverage in California (CMS PDP Region 32).

9 of 12 stand-alone Part D plans in California cover this drug on tier 2–3.

Lowest 30-day cost $0.00 at a preferred pharmacy. 8 of 9 plans apply a prior authorization, step therapy or quantity limit.

242 Medicare Advantage plans in CA 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. CA: 242 plans.

Every plan that covers it

Plan	Tier	30-day preferred	90-day mail	Unit cost	Est. 30-day fill	Restrictions
Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible	2Generic	$0.00	$0.00	$0.4105	$40.2398 units	Prior authorization Quantity limit 98 per 30 days
Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible	2Generic	$1.00	$0.00	$0.4105	$40.2398 units	Prior authorization Quantity limit 98 per 30 days
Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible	2Generic	$4.00	$0.00	$0.4105	$40.2398 units	Prior authorization Quantity limit 98 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible	3Preferred Brand	25%	25%	$4.8412	$38.738 units	Prior authorization Quantity limit 98 per 365 days
HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible	3Preferred Brand	17%	17%	$4.8423	$38.748 units	Prior authorization Quantity limit 98 per 365 days
SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible	3Preferred Brand	18%	18%	$4.5791	$36.638 units	Prior authorization Quantity limit 98 per 365 days
AARP Medicare Rx Saver from UHC (PDP)$109.40/mo premium · $615.00 deductible	3Preferred Brand	17%	17%	$0.4914	$3.938 units	Prior authorization Quantity limit 98 per 365 days
AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible	3Preferred Brand	15%	15%	$0.4914	$3.938 units	Prior authorization Quantity limit 98 per 365 days
Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible	3Preferred Brand	19%	19%	$4.6765	—	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.

See coverage in all 39 regions →