AMLODIPINE, VALSARTAN, HYDROCHLOROTHIAZIDE 5/160/12.5 mg Tablet, Film Coated
Also known as Amlodipine Besylate Valsartan Hydrochlorothiazide. Coverage in Pennsylvania and West Virginia (CMS PDP Region 06).
6 of 12 stand-alone Part D plans in Pennsylvania and West Virginia cover this drug on tier 1–3.
Lowest 30-day cost $2.00 at a preferred pharmacy. 4 of 6 plans apply a prior authorization, step therapy or quantity limit.
149 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: 125 plans · WV: 24 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $2.0445 | $6.133 units |
|
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $1.6350 | $4.913 units |
|
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $1.7912 | $5.373 units |
|
| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $4.8039 | — | None |
| HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $6.9683 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $6.6538 | $19.963 units |
|
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.