AMLODIPINE, VALSARTAN, HYDROCHLOROTHIAZIDE 5/160/12.5 mg Tablet, Film Coated
Also known as Amlodipine Besylate Valsartan Hydrochlorothiazide. Coverage in Connecticut, Massachusetts, Rhode Island and Vermont (CMS PDP Region 02).
5 of 11 stand-alone Part D plans in Connecticut, Massachusetts, Rhode Island and Vermont cover this drug on tier 1–3.
Lowest 30-day cost $2.00 at a preferred pharmacy. 4 of 5 plans apply a prior authorization, step therapy or quantity limit.
97 Medicare Advantage plans in CT, MA, RI 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. CT: 32 plans · MA: 47 plans · RI: 18 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $2.4512 | $7.353 units |
|
| Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $1.5166 | $4.553 units |
|
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $1.6737 | $5.023 units |
|
| HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $6.8064 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $6.6667 | $20.003 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.