MEMANTINE AND DONEPEZIL HYDROCHLORIDES EXTENDED-RELEASE 14/10 mg Capsule, Extended Release
Also known as Memantine And Donepezil. Coverage in New York (CMS PDP Region 03).
4 of 10 stand-alone Part D plans in New York cover this drug on tier 3.
4 of 4 plans apply a prior authorization, step therapy or quantity limit.
96 Medicare Advantage plans in NY 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. NY: 96 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP)$35.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $11.4553 | — |
|
| HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $11.1585 | — |
|
| AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $16.7081 | $50.123 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $16.7607 | $50.283 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.