TOVET (EMOLLIENT FORMULATION) .5 mg/g Aerosol, Foam
Also known as Clobetasol Propionate. Coverage in Pennsylvania and West Virginia (CMS PDP Region 06).
2 of 12 stand-alone Part D plans in Pennsylvania and West Virginia cover this drug on tier 3.
2 of 2 plans apply a prior authorization, step therapy or quantity limit.
14 Medicare Advantage plans in PA 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: 14 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 3Preferred Brand | 25% | 25% | $3.3000 | $3.301 unit |
|
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $3.3000 | $3.301 unit |
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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.