OTEZLA Kit

Also known as Apremilast. Coverage in New Jersey (CMS PDP Region 04).

8 of 12 stand-alone Part D plans in New Jersey cover this drug on tier 5.

8 of 8 plans apply a prior authorization, step therapy or quantity limit.

35 Medicare Advantage plans in NJ 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. NJ: 35 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)$22.80/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$130.3210	$912.257 units	Prior authorization Quantity limit 41 per 180 days
Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$130.3210	$912.257 units	Prior authorization Quantity limit 41 per 180 days
HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$129.9321	$909.527 units	Prior authorization Quantity limit 82 per 365 days
Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$122.0063	$854.047 units	Prior authorization Quantity limit 41 per 180 days
AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$141.8471	$992.937 units	Prior authorization Quantity limit 82 per 365 days
HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$129.9496	$909.657 units	Prior authorization Quantity limit 82 per 365 days
AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible	5Specialty Tier	31%	—	$141.8471	$992.937 units	Prior authorization Quantity limit 82 per 365 days
Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible	5Specialty Tier	30%	—	$122.0063	$854.047 units	Prior authorization Quantity limit 41 per 180 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 →