SAPROPTERIN DIHYDROCHLORIDE 500 mg Powder, For Solution
Coverage in New Mexico (CMS PDP Region 26).
6 of 11 stand-alone Part D plans in New Mexico cover this drug on tier 5.
4 of 6 plans apply a prior authorization, step therapy or quantity limit.
53 Medicare Advantage plans in NM 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. NM: 53 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $102.3911 | — |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $110.4246 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $110.4246 | — | None |
| SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $159.1105 | — |
|
| Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $82.6473 | — |
|
| Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $83.5185 | — |
|
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.