AUSTEDO XR 18 mg Tablet, Film Coated, Extended Release
Also known as Deutetrabenazine. Coverage in Connecticut, Massachusetts, Rhode Island and Vermont (CMS PDP Region 02).
7 of 11 stand-alone Part D plans in Connecticut, Massachusetts, Rhode Island and Vermont cover this drug on tier 5.
7 of 7 plans apply a prior authorization, step therapy or quantity limit.
Every plan that covers it
Showing 7 of 7 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$8.40/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $249.3445 | $748.033 units |
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| Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $253.2554 | $759.773 units |
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| SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $259.6858 | $779.063 units |
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| Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $249.3445 | $748.033 units |
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| Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $249.3445 | $748.033 units |
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| HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $258.7664 | $776.303 units |
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| Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $253.2554 | $759.773 units |
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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.
Medicare Advantage plans
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D, and are sold county by county. Pick a county to see every Medicare Advantage drug plan there that covers this drug.
109 Medicare Advantage plans in CT, MA, RI, VT do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. CT: 29 plans · MA: 68 plans · RI: 10 plans · VT: 2 plans.