OTULFI 45 mg/.5mL Injection, Solution
Also known as Ustekinumab-Aauz. Coverage in Texas (CMS PDP Region 22).
3 of 12 stand-alone Part D plans in Texas cover this drug on tier 3.
Lowest 30-day cost $45.00 at a preferred pharmacy. 3 of 3 plans apply a prior authorization, step therapy or quantity limit.
64 Medicare Advantage plans in TX 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. TX: 64 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $3622.1816 | $1,955.980.54 units |
|
| Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $3622.1816 | $1,955.980.54 units |
|
| Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $3622.1816 | $1,955.980.54 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.