MEMANTINE HYDROCHLORIDE Kit

Coverage in South Carolina (CMS PDP Region 09).

9 of 11 stand-alone Part D plans in South Carolina 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.

60 Medicare Advantage plans in SC 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. SC: 60 plans.

Every plan that covers it

Plan	Tier	30-day preferred	90-day mail	Unit cost	Est. 30-day fill	Restrictions
Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible	2Generic	$2.00	$0.00	$0.4190	$41.0698 units	Prior authorization Quantity limit 98 per 30 days
Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible	2Generic	$0.00	$0.00	$0.4190	$41.0698 units	Prior authorization Quantity limit 98 per 30 days
BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible	2Generic	$17.00	$42.50	$0.4760	—	None
Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible	2Generic	$4.00	$0.00	$0.4190	$41.0698 units	Prior authorization Quantity limit 98 per 30 days
HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible	3Preferred Brand	17%	17%	$4.8169	$38.548 units	Prior authorization Quantity limit 98 per 365 days
SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible	3Preferred Brand	18%	18%	$4.5764	$36.618 units	Prior authorization Quantity limit 98 per 365 days
AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible	3Preferred Brand	18%	18%	$0.4899	$3.928 units	Prior authorization Quantity limit 98 per 365 days
AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible	3Preferred Brand	17%	17%	$0.4899	$3.928 units	Prior authorization Quantity limit 98 per 365 days
HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible	3Preferred Brand	21%	21%	$4.8252	$38.608 units	Prior authorization Quantity limit 98 per 365 days

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 →