JAVYGTOR 100 mg Tablet
Also known as Sapropterin Dihydrochloride. Coverage in Idaho and Utah (CMS PDP Region 31).
1 of 10 stand-alone Part D plans in Idaho and Utah cover this drug on tier 5.
1 of 1 plans apply a prior authorization, step therapy or quantity limit.
23 Medicare Advantage plans in ID, UT 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. ID: 9 plans · UT: 14 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $33.7080 | — |
|
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.