TRAMADOL HYDROCHLORIDE 200 mg Tablet, Extended Release
Coverage in Louisiana (CMS PDP Region 21).
5 of 10 stand-alone Part D plans in Louisiana cover this drug on tier 4.
4 of 5 plans apply a prior authorization, step therapy or quantity limit.
49 Medicare Advantage plans in LA 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. LA: 49 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% | — | $3.3592 | $10.083 units |
|
| Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible | 4Non-Preferred Drug | 35% | — | $3.4008 | $10.203 units |
|
| SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $2.2014 | $6.603 units |
|
| HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $3.3220 | — | None |
| Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $3.3358 | $10.013 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.