OTEZLA Kit

Also known as Apremilast. Coverage in Delaware, DC and Maryland (CMS PDP Region 05).

6 of 10 stand-alone Part D plans in Delaware, DC and Maryland cover this drug on tier 5.

6 of 6 plans apply a prior authorization, step therapy or quantity limit.

64 Medicare Advantage plans in DE, DC, MD 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. DE: 20 plans · DC: 10 plans · MD: 34 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)$5.60/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$97.9868	$881.889 units	Prior authorization Quantity limit 55 per 180 days
Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$97.9868	$881.889 units	Prior authorization Quantity limit 55 per 180 days
HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$98.6326	$88.770.9 units	Prior authorization Quantity limit 11 per 365 days
AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$102.9374	$92.640.9 units	Prior authorization Quantity limit 11 per 365 days
HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$98.6732	$88.810.9 units	Prior authorization Quantity limit 11 per 365 days
AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible	5Specialty Tier	31%	—	$102.9374	$92.640.9 units	Prior authorization Quantity limit 11 per 365 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 →