LIDOCAINE 50 mg/g Ointment
Coverage in Indiana and Kentucky (CMS PDP Region 15).
9 of 10 stand-alone Part D plans in Indiana and Kentucky cover this drug on tier 3–4.
6 of 9 plans apply a prior authorization, step therapy or quantity limit.
219 Medicare Advantage plans in IN, KY 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. IN: 116 plans · KY: 103 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)$127.10/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $0.3532 | $53.69152 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | — | $0.2884 | — | None |
| Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.7000 | $3.505 units |
|
| Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $0.7000 | $3.505 units |
|
| Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $0.2909 | — | None |
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $0.9857 | $34.5035 units |
|
| HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $0.3260 | $1.635 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 42% | — | $0.3532 | $53.69152 units |
|
| Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $0.2871 | — | 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.