PANTOPRAZOLE SODIUM 40 mg Tablet, Delayed Release
Also known as Pantoprazole. Coverage in Mississippi (CMS PDP Region 20).
10 of 10 stand-alone Part D plans in Mississippi cover this drug on tier 1–2.
Lowest 30-day cost $0.00 at a preferred pharmacy. 10 of 10 plans apply a prior authorization, step therapy or quantity limit.
85 Medicare Advantage plans in MS 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. MS: 85 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)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1453 | $0.876 units |
|
| HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1268 | $0.766 units |
|
| Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1011 | $0.616 units |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0646 | $0.396 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.2569 | $1.546 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3081 | $1.856 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.1011 | $0.616 units |
|
| Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.1050 | $0.636 units |
|
| HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1156 | $0.696 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$84.70/mo premium · $615.00 deductible | 2Generic | $6.00 | $18.00 | $0.2950 | $1.776 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.