SODIUM PHENYLBUTYRATE 500 mg Tablet
Also known as Sodium Phenylbutyrate Tablets, 500 Mg. Coverage in Michigan (CMS PDP Region 13).
12 of 12 stand-alone Part D plans in Michigan cover this drug on tier 5.
5 of 12 plans apply a prior authorization, step therapy or quantity limit.
Every plan that covers it
Showing 12 of 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $15.0156 | — |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $15.0046 | — |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $13.8472 | — |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $19.7700 | — | None |
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help | 5Specialty Tier | 26% | — | $19.7700 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.3352 | — | None |
| HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $13.6862 | — |
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| SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $20.0869 | — |
|
| AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $18.3352 | — | None |
| Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $21.9618 | — | None |
| Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $19.7700 | — | None |
| Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $21.9618 | — | 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.
160 Medicare Advantage plans in MI do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. MI: 160 plans.