MESALAMINE .375 g Capsule, Extended Release
Coverage in North Carolina (CMS PDP Region 08).
11 of 12 stand-alone Part D plans in North Carolina cover this drug on tier 3–4.
7 of 11 plans apply a prior authorization, step therapy or quantity limit.
139 Medicare Advantage plans in NC 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. NC: 139 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Saver from UHC (PDP)$56.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.8913 | $10.7012 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $0.8930 | $10.7212 units |
|
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.5074 | — | None |
| Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $1.5074 | — | None |
| Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | — | $1.2001 | $14.4012 units |
|
| Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $1.2136 | $14.5612 units |
|
| HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $2.2593 | — | None |
| Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | 32% | $1.6088 | $19.3112 units |
|
| HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | 32% | $2.3757 | — | None |
| Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1.1924 | $14.3112 units |
|
| Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6088 | $19.3112 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.