ORKAMBI 100/125 mg Tablet, Film Coated

Also known as Lumacaftor And Ivacaftor. Coverage in Alabama and Tennessee (CMS PDP Region 12).

7 of 12 stand-alone Part D plans in Alabama and Tennessee cover this drug on tier 5.

7 of 7 plans apply a prior authorization, step therapy or quantity limit.

172 Medicare Advantage plans in AL, TN 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. AL: 72 plans · TN: 100 plans.

Every plan that covers it

Plan	Tier	30-day preferred	90-day mail	Unit cost	Est. 30-day fill	Restrictions
AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$215.8738	$25,904.86120 units	Prior authorization Quantity limit 112 per 28 days
BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible	5Specialty Tier	25%	25%	$212.0088	$2,544.1112 units	Prior authorization Quantity limit 12 per 30 days
HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$197.7346	$23,728.15120 units	Prior authorization Quantity limit 112 per 28 days
HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$197.7614	$23,731.37120 units	Prior authorization Quantity limit 112 per 28 days
SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$219.1575	$26,298.90120 units	Prior authorization Quantity limit 112 per 28 days
AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible	5Specialty Tier	31%	—	$215.8738	$25,904.86120 units	Prior authorization Quantity limit 112 per 28 days
BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible	5Specialty Tier	31%	31%	$212.0088	$2,544.1112 units	Prior authorization Quantity limit 12 per 30 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.

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