FAMCICLOVIR 500 mg Tablet, Film Coated
Coverage in Missouri (CMS PDP Region 18).
8 of 10 stand-alone Part D plans in Missouri cover this drug on tier 2–4.
Lowest 30-day cost $3.00 at a preferred pharmacy. 7 of 8 plans apply a prior authorization, step therapy or quantity limit.
141 Medicare Advantage plans in MO 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. MO: 141 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)$9.60/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $0.4022 | — | None |
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $3.2309 | $19.396 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $1.1379 | $23.9021 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $1.0202 | $9.189 units |
|
| Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.2185 | $10.979 units |
|
| Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | — | $1.2302 | $11.079 units |
|
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $1.2510 | $11.269 units |
|
| HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $2.5099 | $15.066 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.