ABILIFY ASIMTUFII 960 mg/3.2mL Injection, Suspension, Extended Release

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

10 of 10 stand-alone Part D plans in Delaware, DC and Maryland cover this drug on tier 4–5.

10 of 10 plans apply a prior authorization, step therapy or quantity limit.

92 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: 29 plans · DC: 15 plans · MD: 48 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)$0.00/mo premium · $615.00 deductible	4Non-Preferred Drug	33%	—	$1772.7021	$3,545.402 units	Quantity limit 3.2 per 56 days
Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible	4Non-Preferred Drug	33%	—	$1772.7021	$3,545.402 units	Quantity limit 3.2 per 56 days
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible	4Non-Preferred Drug	50%	50%	$1772.7021	$3,545.402 units	Quantity limit 3.2 per 56 days
Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1685.7808	$3,371.562 units	Quantity limit 3.2 per 56 days
Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1685.7808	$3,371.562 units	Quantity limit 3.2 per 56 days
HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1706.4372	$3,412.872 units	Quantity limit 3.2 per 56 days
AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1898.5022	$3,797.002 units	Quantity limit 3.2 per 56 days
HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1706.5744	$3,413.152 units	Quantity limit 3.2 per 56 days
AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible	5Specialty Tier	31%	—	$1898.5022	$3,797.002 units	Quantity limit 3.2 per 56 days
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1839.8161	$3,679.632 units	Quantity limit 3.2 per 56 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 →