YF-VAX 4.74 [PFU]/.5mL Injection, Powder, Lyophilized, For Suspension
Also known as Yellow Fever Virus Strain 17D-204 Live Antigen. Coverage in Pennsylvania and West Virginia (CMS PDP Region 06).
12 of 12 stand-alone Part D plans in Pennsylvania and West Virginia cover this drug on tier 1–3.
Lowest 30-day cost $0.00 at a preferred pharmacy. 2 of 12 plans apply a prior authorization, step therapy or quantity limit.
365 Medicare Advantage plans in PA, WV 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. PA: 306 plans · WV: 59 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)$6.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $245.0702 | — | None |
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $245.0702 | — | None |
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $239.9280 | — | None |
| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $245.0702 | — | None |
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $237.1519 | — | None |
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $237.1519 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $267.7124 | $8,031.3730 units |
|
| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $240.7061 | — | None |
| HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $240.5186 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $267.7124 | $8,031.3730 units |
|
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 3Preferred Brand | 25% | 25% | $245.5784 | — | None |
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $245.6707 | — | 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.