BUPROPION HYDROCHLORIDE SR 200 mg Tablet, Film Coated, Extended Release
Also known as Bupropion Hydrochloride. Coverage in Connecticut, Massachusetts, Rhode Island and Vermont (CMS PDP Region 02).
11 of 11 stand-alone Part D plans in Connecticut, Massachusetts, Rhode Island and Vermont cover this drug on tier 2–3.
Lowest 30-day cost $3.00 at a preferred pharmacy. 9 of 11 plans apply a prior authorization, step therapy or quantity limit.
152 Medicare Advantage plans in CT, MA, RI, VT 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: 42 plans · MA: 88 plans · RI: 20 plans · VT: 2 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible | 2Generic | $3.00 | $6.00 | $0.2534 | $1.526 units |
|
| SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.2453 | $1.476 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $0.2282 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.3566 | — | None |
| Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible | 2Generic | $7.00 | $14.00 | $0.2534 | $1.526 units |
|
| Humana Basic Rx Plan (PDP)$8.40/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.1726 | $1.046 units |
|
| Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $0.5897 | $3.546 units |
|
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $0.5919 | $3.556 units |
|
| Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible | 3Preferred Brand | 18% | 13% | $0.1733 | $1.046 units |
|
| Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.1722 | $1.036 units |
|
| HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $0.2345 | $1.416 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.