RIVAROXABAN 155 mg Granule, For Suspension
Coverage in California (CMS PDP Region 32).
10 of 12 stand-alone Part D plans in California cover this drug on tier 2–3.
Lowest 30-day cost $3.00 at a preferred pharmacy. 6 of 10 plans apply a prior authorization, step therapy or quantity limit.
300 Medicare Advantage plans in CA 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. CA: 300 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)$5.70/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $1.9468 | — | None |
| Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $1.9468 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $2.0014 | — | None |
| HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.9729 | — | None |
| SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $3.1881 | $197.6662 units |
|
| Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible | 3Preferred Brand | 18% | 13% | $2.6276 | $15.776 units |
|
| Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $2.6276 | $15.776 units |
|
| Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $2.6276 | $15.776 units |
|
| Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $2.6193 | $157.1660 units |
|
| Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible | 3Preferred Brand | 19% | 19% | $2.6193 | $157.1660 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.