OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 40/12.5 mg Tablet
Coverage in Maine and New Hampshire (CMS PDP Region 01).
8 of 9 stand-alone Part D plans in Maine and New Hampshire cover this drug on tier 1–4.
Lowest 30-day cost $0.00 at a preferred pharmacy. 7 of 8 plans apply a prior authorization, step therapy or quantity limit.
61 Medicare Advantage plans in ME, NH 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. ME: 45 plans · NH: 16 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 | $0.1321 | $0.403 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | 5% | 5% | $0.3693 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6738 | $2.023 units |
|
| Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6826 | $2.053 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.4946 | $1.483 units |
|
| Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6738 | $2.023 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.2273 | $3.683 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.5457 | $1.643 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.