MedicarePartD.guide

A non-government resource built from CMS public data

LYTGOBI 4 mg Tablet

Also known as Futibatinib. Coverage in Virginia (CMS PDP Region 07).

9 of 9 stand-alone Part D plans in Virginia cover this drug on tier 5.

9 of 9 plans apply a prior authorization, step therapy or quantity limit.

Every plan that covers it

Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 9 of 9 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help5Specialty Tier25%—$221.2500$3,318.7515 units
  • Prior authorization
  • Quantity limit 14 per 28 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help5Specialty Tier25%—$221.2500$3,318.7515 units
  • Prior authorization
  • Quantity limit 14 per 28 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help5Specialty Tier25%—$173.3049$2,599.5715 units
  • Prior authorization
  • Quantity limit 14 per 28 days
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help5Specialty Tier26%—$173.3049$2,599.5715 units
  • Prior authorization
  • Quantity limit 14 per 28 days
AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible5Specialty Tier25%—$178.9283$2,683.9215 units
  • Prior authorization
  • Quantity limit 14 per 28 days
SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible5Specialty Tier25%—$185.8419$2,787.6315 units
  • Prior authorization
  • Quantity limit 14 per 28 days
Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible5Specialty Tier33%—$173.3049$2,599.5715 units
  • Prior authorization
  • Quantity limit 14 per 28 days
AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible5Specialty Tier31%—$178.9283$2,683.9215 units
  • Prior authorization
  • Quantity limit 14 per 28 days
HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible5Specialty Tier25%—$164.8810$2,473.2215 units
  • Prior authorization
  • Quantity limit 15 per 30 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.

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.

128 Medicare Advantage plans in VA do cover it

A patient on an MA-PD plan may have coverage even where no PDP lists the drug. VA: 128 plans.

See coverage in all 39 regions →