MIRTAZAPINE 30 mg Tablet, Orally Disintegrating
Coverage in Ohio (CMS PDP Region 14).
10 of 10 stand-alone Part D plans in Ohio cover this drug on tier 2–4.
Lowest 30-day cost $3.00 at a preferred pharmacy. 6 of 10 plans apply a prior authorization, step therapy or quantity limit.
193 Medicare Advantage plans in OH 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. OH: 193 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)$7.60/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $0.3345 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5434 | — | None |
| Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.4081 | — | None |
| HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.0955 | $3.293 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.5499 | — | None |
| SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.2616 | $0.783 units |
|
| HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $0.9204 | $2.763 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | — | $0.6241 | $1.873 units |
|
| Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $0.6308 | $1.893 units |
|
| Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $0.6203 | $1.863 units |
|
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.