PITAVASTATIN 4 mg Tablet, Film Coated
Coverage in Idaho and Utah (CMS PDP Region 31).
4 of 10 stand-alone Part D plans in Idaho and Utah cover this drug on tier 1–4.
Lowest 30-day cost $0.00 at a preferred pharmacy. 4 of 4 plans apply a prior authorization, step therapy or quantity limit.
20 Medicare Advantage plans in ID, UT 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. ID: 7 plans · UT: 13 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $1.6949 | $5.083 units |
|
| HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $2.5563 | $7.673 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $3.6144 | $10.843 units |
|
| Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $3.6144 | $10.843 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.