MIEBO 1 mg/mg Solution
Also known as Perfluorohexyloctane. Coverage in Delaware, DC and Maryland (CMS PDP Region 05).
5 of 10 stand-alone Part D plans in Delaware, DC and Maryland cover this drug on tier 3–4.
5 of 5 plans apply a prior authorization, step therapy or quantity limit.
76 Medicare Advantage plans in DE, DC, MD 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. DE: 20 plans · DC: 13 plans · MD: 43 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $251.4635 | $754.393 units |
|
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $251.4635 | $754.393 units |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $260.2952 | $780.893 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $270.8952 | $3,250.7412 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible | 4Non-Preferred Drug | 34% | — | $278.0442 | $3,336.5312 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.