CALCIPOTRIENE 50 ug/g Cream
Coverage in Delaware, DC and Maryland (CMS PDP Region 05).
8 of 10 stand-alone Part D plans in Delaware, DC and Maryland cover this drug on tier 4.
8 of 8 plans apply a prior authorization, step therapy or quantity limit.
94 Medicare Advantage plans in DE, DC, MD 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. DE: 29 plans · DC: 15 plans · MD: 50 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | — | $1.9984 | $23.9812 units |
|
| Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible | 4Non-Preferred Drug | 33% | — | $2.0141 | $24.1712 units |
|
| HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $3.1140 | $37.3712 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 36% | — | $1.6435 | $19.7212 units |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | 32% | $3.8792 | $46.5512 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible | 4Non-Preferred Drug | 34% | — | $1.6493 | $19.7912 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6813 | $20.1812 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1.9896 | $23.8812 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.