LIDOCAINE 50 mg/g Ointment
Coverage in Alabama and Tennessee (CMS PDP Region 12).
8 of 12 stand-alone Part D plans in Alabama and Tennessee cover this drug on tier 3–4.
5 of 8 plans apply a prior authorization, step therapy or quantity limit.
210 Medicare Advantage plans in AL, TN 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. AL: 88 plans · TN: 122 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $0.2447 | $37.19152 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 34% | — | $0.2981 | — | None |
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.6880 | $3.445 units |
|
| Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $0.6880 | $3.445 units |
|
| Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible | 4Non-Preferred Drug | 33% | — | $0.3011 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | — | $0.2447 | $37.19152 units |
|
| HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $0.3843 | $1.925 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $0.2965 | — | None |
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.