BACLOFEN 5 mg Tablet
Coverage in Pennsylvania and West Virginia (CMS PDP Region 06).
9 of 12 stand-alone Part D plans in Pennsylvania and West Virginia cover this drug on tier 2–3.
Lowest 30-day cost $0.00 at a preferred pharmacy. 3 of 9 plans apply a prior authorization, step therapy or quantity limit.
284 Medicare Advantage plans in PA, WV 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. PA: 236 plans · WV: 48 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $0.1184 | — | None |
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.2552 | $2.309 units |
|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.2037 | — | None |
| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $0.1476 | — | None |
| HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1441 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.2981 | — | None |
| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.2499 | $2.259 units |
|
| Humana Basic Rx Plan (PDP)$6.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.2499 | $2.259 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $0.1778 | — | 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.