INFANRIX 10/25/25/25/8 [iU]/.5mL/ug/.5mL Suspension
Also known as Diphtheria And Tetanus Toxoids And Acellular Pertussis Vaccine Adsorbed. Coverage in New York (CMS PDP Region 03).
10 of 10 stand-alone Part D plans in New York cover this drug on tier 1–3.
Lowest 30-day cost $0.00 at a preferred pharmacy. 2 of 10 plans apply a prior authorization, step therapy or quantity limit.
192 Medicare Advantage plans in NY 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. NY: 192 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $61.7654 | — | None |
| Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $56.9109 | — | None |
| Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $56.9109 | — | None |
| Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $56.9109 | — | None |
| HealthSpring Assurance Rx (PDP)$35.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $57.7842 | — | None |
| Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $57.8913 | — | None |
| Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $57.8913 | — | None |
| HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $57.7765 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $63.0692 | $946.0415 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $63.0692 | $946.0415 units |
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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.