SPRITAM 500 mg Tablet, For Suspension
Also known as Levetiracetam. Coverage in Delaware, DC and Maryland (CMS PDP Region 05).
10 of 10 stand-alone Part D plans in Delaware, DC and Maryland cover this drug on tier 3–4.
6 of 10 plans apply a prior authorization, step therapy or quantity limit.
Every plan that covers it
Showing 10 of 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 33% | — | $10.3450 | $186.2118 units |
|
| Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible | 4Non-Preferred Drug | 33% | — | $10.3450 | $186.2118 units |
|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $9.9468 | — | None |
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible · $0 with full Extra Help | 3Preferred Brand | 25% | 25% | $9.9468 | — | None |
| HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $10.2455 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 36% | — | $10.8173 | $194.7118 units |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | 32% | $10.2459 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible | 4Non-Preferred Drug | 34% | — | $10.8173 | $194.7118 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $10.5953 | $190.7218 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $10.3450 | $186.2118 units |
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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.
84 Medicare Advantage plans in DC, DE, MD do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. DC: 12 plans · DE: 32 plans · MD: 40 plans.