CALCIPOTRIENE 50 ug/g Ointment
Coverage in Pennsylvania and West Virginia (CMS PDP Region 06).
7 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. 7 of 7 plans apply a prior authorization, step therapy or quantity limit.
301 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: 259 plans · WV: 42 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 2Generic | $5.00 | $12.50 | $2.5794 | $15.486 units |
|
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 2Generic | 25% | 25% | $2.5794 | $15.486 units |
|
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $4.0580 | $48.7012 units |
|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $2.3623 | $28.3512 units |
|
| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $3.6886 | $44.2612 units |
|
| HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $3.6561 | $43.8712 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 4Non-Preferred Drug | 33% | — | $2.5951 | $31.1412 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.