HAEGARDA C1 ESTERASE INHIBITOR SUBCUTANEOUS (HUMAN) Kit

Also known as Human C1-Esterase Inhibitor. Coverage in New Jersey (CMS PDP Region 04).

11 of 12 stand-alone Part D plans in New Jersey cover this drug on tier 5.

11 of 11 plans apply a prior authorization, step therapy or quantity limit.

70 Medicare Advantage plans in NJ 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. NJ: 70 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)$4.40/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$3789.2445	$98,520.3626 units	Prior authorization Quantity limit 24 per 28 days
Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$3605.3950	$7,210.792 units	Prior authorization Quantity limit 2 per 30 days
Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$3605.3950	$7,210.792 units	Prior authorization Quantity limit 2 per 30 days
Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible	5Specialty Tier	26%	—	$3789.2445	$98,520.3626 units	Prior authorization Quantity limit 24 per 28 days
HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$3598.2403	—	Prior authorization
Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$3747.7628	$71,207.4919 units	Prior authorization Quantity limit 18 per 28 days
AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$3928.4986	—	Prior authorization
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$3968.1207	$7,936.242 units	Prior authorization Quantity limit 2 per 30 days
Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible	5Specialty Tier	33%	—	$3789.2445	$98,520.3626 units	Prior authorization Quantity limit 24 per 28 days
AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible	5Specialty Tier	31%	—	$3928.4986	—	Prior authorization
Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible	5Specialty Tier	30%	—	$3747.7628	$71,207.4919 units	Prior authorization Quantity limit 18 per 28 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.

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