OTULFI 45 mg/.5mL Injection, Solution
Also known as Ustekinumab-Aauz. Coverage in Virginia (CMS PDP Region 07).
3 of 9 stand-alone Part D plans in Virginia 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.
37 Medicare Advantage plans in VA 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. VA: 37 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $3632.3239 | $1,961.450.54 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $3632.3239 | $1,961.450.54 units |
|
| Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $3632.3239 | $1,961.450.54 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.