MedicarePartD.guide

A non-government resource built from CMS public data

PIRFENIDONE 267 mg Capsule

Coverage in Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming (CMS PDP Region 25).

9 of 11 stand-alone Part D plans in Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming cover this drug on tier 5.

9 of 9 plans apply a prior authorization, step therapy or quantity limit.

Every plan that covers it

Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 9 of 9 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$4.70/mo premium · $615.00 deductible · $0 with full Extra Help5Specialty Tier25%—$14.8310$400.4427 units
  • Prior authorization
  • Quantity limit 27 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$5.30/mo premium · $615.00 deductible · $0 with full Extra Help5Specialty Tier25%—$2.6501$71.5527 units
  • Prior authorization
  • Quantity limit 27 per 30 days
Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible5Specialty Tier26%—$14.8310$400.4427 units
  • Prior authorization
  • Quantity limit 27 per 30 days
SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible · $0 with full Extra Help5Specialty Tier25%—$19.7177$532.3827 units
  • Prior authorization
  • Quantity limit 27 per 30 days
HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible5Specialty Tier25%—$2.9161$78.7327 units
  • Prior authorization
  • Quantity limit 27 per 30 days
MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible5Specialty Tier25%—$4.0345$108.9327 units
  • Prior authorization
  • Quantity limit 27 per 30 days
Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible5Specialty Tier33%—$14.8310$400.4427 units
  • Prior authorization
  • Quantity limit 27 per 30 days
HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible5Specialty Tier25%—$2.7296$73.7027 units
  • Prior authorization
  • Quantity limit 27 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible5Specialty Tier31%—$2.6501$71.5527 units
  • Prior authorization
  • Quantity limit 27 per 30 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.

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.

229 Medicare Advantage plans in IA, MN, MT, ND, NE, SD, WY do cover it

A patient on an MA-PD plan may have coverage even where no PDP lists the drug. IA: 48 plans · MN: 69 plans · MT: 25 plans · ND: 22 plans · NE: 38 plans · SD: 19 plans · WY: 8 plans.

See coverage in all 39 regions →