PANTOPRAZOLE SODIUM 20 mg Tablet, Delayed Release
Coverage in Illinois (CMS PDP Region 17).
12 of 12 stand-alone Part D plans in Illinois cover this drug on tier 1–2.
Lowest 30-day cost $0.00 at a preferred pharmacy. 12 of 12 plans apply a prior authorization, step therapy or quantity limit.
137 Medicare Advantage plans in IL 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. IL: 137 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0847 | $0.516 units |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0893 | $0.546 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0709 | $0.213 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.2366 | $2.139 units |
|
| Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1266 | $0.766 units |
|
| Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2291 | $0.693 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3612 | $2.176 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.1266 | $0.766 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.1285 | $0.776 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$40.20/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $0.2911 | $2.629 units |
|
| Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible | 2Generic | $5.00 | $15.00 | $0.2228 | $0.673 units |
|
| HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1277 | $0.776 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.