SUFLAVE Kit
Also known as Polyethylene Glycol 3350, Sodium Sulfate, Potassium Chloride, Magnesium Sulfate, And Sodium Chloride For Oral Solution. Coverage in New York (CMS PDP Region 03).
6 of 10 stand-alone Part D plans in New York cover this drug on tier 4.
No plan applies a prior authorization, step therapy or quantity limit.
Every plan that covers it
Showing 6 of 6 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP)$35.70/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 29% | 29% | $58.8981 | — | None |
| HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $58.9163 | — | None |
| Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | — | $61.2203 | — | None |
| Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible | 4Non-Preferred Drug | 31% | — | $61.2203 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible | 4Non-Preferred Drug | 28% | — | $64.9589 | — | None |
| Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $61.2203 | — | 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.
36 Medicare Advantage plans in NY do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. NY: 36 plans.