TRIKAFTA Kit

Also known as Elexacaftor, Tezacaftor, And Ivacaftor. Coverage in Virginia (CMS PDP Region 07).

9 of 9 stand-alone Part D plans in Virginia cover this drug on tier 5.

9 of 9 plans apply a prior authorization, step therapy or quantity limit.

126 Medicare Advantage plans in VA 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. VA: 126 plans.

Every plan that covers it

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	5Specialty Tier	25%	—	$484.8024	$29,088.1460 units	Prior authorization Quantity limit 56 per 28 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$484.8024	$29,088.1460 units	Prior authorization Quantity limit 56 per 28 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$509.0040	$30,540.2460 units	Prior authorization Quantity limit 56 per 28 days
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible	5Specialty Tier	26%	—	$509.0040	$30,540.2460 units	Prior authorization Quantity limit 56 per 28 days
AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$527.7100	$31,662.6060 units	Prior authorization Quantity limit 56 per 28 days
SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$535.7374	$32,144.2460 units	Prior authorization Quantity limit 56 per 28 days
Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible	5Specialty Tier	33%	—	$509.0040	$30,540.2460 units	Prior authorization Quantity limit 56 per 28 days
AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible	5Specialty Tier	31%	—	$527.7100	$31,662.6060 units	Prior authorization Quantity limit 56 per 28 days
HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$483.4205	$29,005.2360 units	Prior authorization Quantity limit 56 per 28 days

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.

See coverage in all 39 regions →