ARISTADA 1064 mg/3.9mL Injection, Suspension, Extended Release
Also known as Aripiprazole Lauroxil. Coverage in Wisconsin (CMS PDP Region 16).
8 of 10 stand-alone Part D plans in Wisconsin cover this drug on tier 4–5.
6 of 8 plans apply a prior authorization, step therapy or quantity limit.
88 Medicare Advantage plans in WI 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. WI: 88 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 | 32% | — | $986.4636 | $1,972.932 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 4Non-Preferred Drug | 35% | — | $986.4636 | $1,972.932 units |
|
| Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $986.4636 | $1,972.932 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $978.2444 | $1,956.492 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $978.2444 | $1,956.492 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1091.5609 | — | None |
| SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1026.6232 | $2,053.252 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1091.5609 | — | 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.