AMLODIPINE AND OLMESARTAN MEDOXOMIL 10/20 mg Tablet
Coverage in Pennsylvania and West Virginia (CMS PDP Region 06).
6 of 12 stand-alone Part D plans in Pennsylvania and West Virginia cover this drug on tier 1–3.
Lowest 30-day cost $0.00 at a preferred pharmacy. 6 of 6 plans apply a prior authorization, step therapy or quantity limit.
362 Medicare Advantage plans in PA, WV 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. PA: 303 plans · WV: 59 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)$8.20/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1832 | $0.553 units |
|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1211 | $0.363 units |
|
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 2Generic | $5.00 | $12.50 | $0.4368 | $13.1030 units |
|
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 2Generic | 25% | 25% | $0.4368 | $13.1030 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $0.3599 | $1.083 units |
|
| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.7947 | $2.383 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.