PLENVU Kit
Also known as Polyethylene Glycol 3350, Sodium Sulfate, Sodium Chloride, Potassium Chloride, Ascorbic Acid, Sodium Ascorbate. Coverage in Delaware, DC and Maryland (CMS PDP Region 05).
2 of 10 stand-alone Part D plans in Delaware, DC and Maryland cover this drug on tier 4.
No plan applies a prior authorization, step therapy or quantity limit.
Every plan that covers it
Showing 2 of 2 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $46.8022 | — | None |
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 31% | 31% | $46.8022 | — | 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.
23 Medicare Advantage plans in DC, DE, MD do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. DC: 3 plans · DE: 11 plans · MD: 9 plans.