AMMONIUM LACTATE 12 g/100g Lotion
Coverage in Oregon and Washington (CMS PDP Region 30).
10 of 10 stand-alone Part D plans in Oregon and Washington cover this drug on tier 2–4.
Lowest 30-day cost $0.00 at a preferred pharmacy. No plan applies a prior authorization, step therapy or quantity limit.
179 Medicare Advantage plans in OR, WA 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. OR: 83 plans · WA: 96 plans.
Every plan that covers it
| 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 | 2Generic | $1.00 | $0.00 | $0.0899 | — | None |
| Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.0918 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.0899 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.0585 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 24% | 24% | $0.0942 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.0754 | — | None |
| HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $0.0979 | — | None |
| SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.0784 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $0.1050 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.1050 | — | None |
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.