IPOL 40/8/32 [D'ag'U]/.5mL Injection, Suspension
Also known as Poliovirus Type 1 Antigen (Formaldehyde Inactivated), Poliovirus Type 2 Antigen (Formaldehyde Inactivated), And Poliovirus Type 3 Antigen (Formaldehyde Inactivated). Coverage in Colorado (CMS PDP Region 27).
10 of 10 stand-alone Part D plans in Colorado cover this drug on tier 1–3.
Lowest 30-day cost $0.00 at a preferred pharmacy. 2 of 10 plans apply a prior authorization, step therapy or quantity limit.
96 Medicare Advantage plans in CO 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. CO: 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 | 1Preferred Generic | $0.00 | $0.00 | $89.9126 | — | None |
| Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $89.9126 | — | None |
| SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $89.2679 | — | None |
| Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $89.9126 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $44.0161 | — | None |
| Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $44.0161 | — | None |
| HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $44.4925 | — | None |
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $44.5452 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$125.00/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $98.7076 | $1,480.6115 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $98.7076 | $1,480.6115 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.