AMLODIPINE, VALSARTAN, HYDROCHLOROTHIAZIDE 5/160/25 mg Tablet, Film Coated
Also known as Amlodipine Besylate Valsartan Hydrochlorothiazide. Coverage in California (CMS PDP Region 32).
7 of 12 stand-alone Part D plans in California cover this drug on tier 2–4.
Lowest 30-day cost $3.00 at a preferred pharmacy. 3 of 7 plans apply a prior authorization, step therapy or quantity limit.
283 Medicare Advantage plans in CA 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. CA: 283 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $1.4472 | $4.343 units |
|
| Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $1.6079 | $4.823 units |
|
| Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible | 2Generic | $7.00 | $14.00 | $15.7715 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $6.7892 | — | None |
| HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $4.9436 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $6.6347 | $19.903 units |
|
| Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 49% | 49% | $15.7715 | — | None |
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.