SUMATRIPTAN 5 mg Spray
Coverage in Hawaii (CMS PDP Region 33).
5 of 8 stand-alone Part D plans in Hawaii cover this drug on tier 2–4.
Lowest 30-day cost $10.00 at a preferred pharmacy. 5 of 5 plans apply a prior authorization, step therapy or quantity limit.
38 Medicare Advantage plans in HI 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. HI: 38 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $4.0902 | $49.0812 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 38% | — | $30.5438 | $366.5312 units |
|
| Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $48.3308 | $918.2919 units |
|
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $48.3308 | $918.2919 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 4Non-Preferred Drug | 34% | — | $30.3740 | $364.4912 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.