PROCRIT 4000 [iU]/mL Injection, Solution
Also known as Erythropoietin. Coverage in Louisiana (CMS PDP Region 21).
3 of 10 stand-alone Part D plans in Louisiana cover this drug on tier 3–4.
3 of 3 plans apply a prior authorization, step therapy or quantity limit.
59 Medicare Advantage plans in LA 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. LA: 59 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $105.1896 | — |
|
| AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | — | $113.0790 | — |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible | 4Non-Preferred Drug | 36% | — | $113.0790 | — |
|
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.