ARISTADA 1064 mg/3.9mL Injection, Suspension, Extended Release

Also known as Aripiprazole Lauroxil. Coverage in Michigan (CMS PDP Region 13).

10 of 12 stand-alone Part D plans in Michigan cover this drug on tier 4–5.

8 of 10 plans apply a prior authorization, step therapy or quantity limit.

123 Medicare Advantage plans in MI 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. MI: 123 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	4Non-Preferred Drug	33%	—	$985.8842	$1,971.772 units	Quantity limit 3.9 per 56 days
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible	4Non-Preferred Drug	33%	—	$985.8842	$1,971.772 units	Quantity limit 3.9 per 56 days
Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible	4Non-Preferred Drug	50%	50%	$985.8842	$1,971.772 units	Quantity limit 3.9 per 56 days
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$968.5376	$1,937.082 units	Quantity limit 3.9 per 56 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$968.5376	$1,937.082 units	Quantity limit 3.9 per 56 days
AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1079.2290	—	None
SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1026.8172	$2,053.632 units	Quantity limit 3.9 per 56 days
AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible	5Specialty Tier	31%	—	$1079.2290	—	None
Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1014.2566	$2,028.512 units	Step therapy Quantity limit 3.9 per 56 days
Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible	5Specialty Tier	33%	—	$1014.2566	$2,028.512 units	Step therapy Quantity limit 3.9 per 56 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.

See coverage in all 39 regions →