DEXTROAMPHETAMINE SULFATE 15 mg Capsule, Extended Release
Coverage in Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming (CMS PDP Region 25).
5 of 11 stand-alone Part D plans in Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming cover this drug on tier 4.
3 of 5 plans apply a prior authorization, step therapy or quantity limit.
Every plan that covers it
Showing 5 of 5 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $3.6867 | $44.2412 units |
|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 35% | 35% | $1.4201 | $17.0412 units |
|
| HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $2.9286 | — | None |
| HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $2.1790 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible | 4Non-Preferred Drug | 34% | — | $1.7506 | $21.0112 units |
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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.
Medicare Advantage plans
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D, and are sold county by county. Pick a county to see every Medicare Advantage drug plan there that covers this drug.
120 Medicare Advantage plans in IA, MN, MT, ND, NE, SD, WY do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. IA: 28 plans · MN: 35 plans · MT: 8 plans · ND: 12 plans · NE: 23 plans · SD: 10 plans · WY: 4 plans.