GLYCOPYRROLATE 1 mg/5mL Solution
Coverage in Connecticut, Massachusetts, Rhode Island and Vermont (CMS PDP Region 02).
1 of 11 stand-alone Part D plans in Connecticut, Massachusetts, Rhode Island and Vermont cover this drug on tier 4.
No plan applies a prior authorization, step therapy or quantity limit.
60 Medicare Advantage plans in CT, MA, RI 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. CT: 10 plans · MA: 47 plans · RI: 3 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $0.5654 | — | 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.