SULFAMYLON 85 mg/g Cream
Also known as Mafenide Acetate. Coverage in Indiana and Kentucky (CMS PDP Region 15).
1 of 10 stand-alone Part D plans in Indiana and Kentucky cover this drug on tier 4.
No plan applies a prior authorization, step therapy or quantity limit.
Every plan that covers it
Showing 1 of 1 plan
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 35% | 35% | $1.2571 | — | 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.
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.
78 Medicare Advantage plans in IN, KY do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. IN: 50 plans · KY: 28 plans.