ESOMEPRAZOLE MAGNESIUM 40 mg Capsule, Delayed Release
Coverage in Pennsylvania and West Virginia (CMS PDP Region 06).
9 of 12 stand-alone Part D plans in Pennsylvania and West Virginia cover this drug on tier 2–4.
Lowest 30-day cost $5.00 at a preferred pharmacy. 9 of 9 plans apply a prior authorization, step therapy or quantity limit.
353 Medicare Advantage plans in PA, WV 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. PA: 294 plans · WV: 59 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3336 | $1.003 units |
|
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 2Generic | $5.00 | $12.50 | $0.2610 | $7.8330 units |
|
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 2Generic | 25% | 25% | $0.2610 | $7.8330 units |
|
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.2381 | $1.436 units |
|
| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.3366 | $2.026 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $0.2161 | $1.306 units |
|
| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.2336 | $1.406 units |
|
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.9610 | $5.776 units |
|
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $0.9610 | $5.776 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.