METHOXSALEN 10 mg Capsule, Liquid Filled
Coverage in Maine and New Hampshire (CMS PDP Region 01).
3 of 9 stand-alone Part D plans in Maine and New Hampshire cover this drug on tier 5.
No plan applies a prior authorization, step therapy or quantity limit.
Every plan that covers it
Showing 3 of 3 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $40.4800 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $62.5863 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $58.4141 | — | 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.
Medicare Advantage plans
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D, and are sold county by county. Pick a county to see every Medicare Advantage drug plan there that covers this drug.
39 Medicare Advantage plans in ME, NH do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. ME: 27 plans · NH: 12 plans.