AREXVY Kit

Also known as Respiratory Syncytial Virus Vaccine Recombinant, Adjuvanted. Coverage in Pennsylvania and West Virginia (CMS PDP Region 06).

12 of 12 stand-alone Part D plans in Pennsylvania and West Virginia cover this drug on tier 1–4.

Lowest 30-day cost $0.00 at a preferred pharmacy. 7 of 12 plans apply a prior authorization, step therapy or quantity limit.

365 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: 306 plans · WV: 59 plans.

Every plan that covers it

Plan	Tier	30-day preferred	90-day mail	Unit cost	Est. 30-day fill	Restrictions
Humana Basic Rx Plan (PDP)$6.60/mo premium · $615.00 deductible	1Preferred Generic	$0.00	$0.00	$310.2166	—	None
Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible	1Preferred Generic	$0.00	$0.00	$310.2166	—	None
Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible	1Preferred Generic	$0.00	$0.00	$310.2166	—	None
Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible	3Preferred Brand	25%	25%	$293.3390	—	None
SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible	3Preferred Brand	19%	19%	$300.7400	$9.020.03 units	Prior authorization Quantity limit 1 per 999 days
AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible	3Preferred Brand	16%	16%	$325.9647	$9,778.9430 units	Prior authorization Quantity limit 1 per 1 days
HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible	3Preferred Brand	17%	17%	$305.5805	$24.450.08 units	Prior authorization Quantity limit 1 per 365 days
HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible	3Preferred Brand	21%	21%	$305.5902	$24.450.08 units	Prior authorization Quantity limit 1 per 365 days
AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible	3Preferred Brand	16%	16%	$325.9647	$9,778.9430 units	Prior authorization Quantity limit 1 per 1 days
Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible	3Preferred Brand	25%	25%	$306.4139	$24.510.08 units	Quantity limit 1 per 365 days
Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible	3Preferred Brand	25%	25%	$306.7712	$24.540.08 units	Quantity limit 1 per 365 days
Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible	4Non-Preferred Drug	28%	28%	$293.3390	—	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.

See coverage in all 39 regions →