BUPRENORPHINE AND NALOXONE SUBLINGUAL FILM 12/3 mg Film
Also known as Buprenorphine And Naloxone. 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. 1 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 |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 38% | — | $6.0115 | — | None |
| SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help | 2Generic | $10.00 | $30.00 | $0.5400 | $4.869 units |
|
| Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $11.2000 | — | None |
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 35% | 35% | $11.2000 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 4Non-Preferred Drug | 34% | — | $6.0115 | — | 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.
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.
27 Medicare Advantage plans in HI do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. HI: 27 plans.