BUTALBITAL, ACETAMINOPHEN AND CAFFEINE 50/325/40 mg Capsule
Coverage in California (CMS PDP Region 32).
1 of 12 stand-alone Part D plans in California cover this drug on tier 4.
1 of 1 plans apply a prior authorization, step therapy or quantity limit.
77 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: 77 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible | 4Non-Preferred Drug | 37% | 37% | $8.1378 | $390.6148 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.