MedicarePartD.guide

A non-government resource built from CMS public data

INGREZZA 40 mg Capsule

Also known as Valbenazine. Coverage in New York (CMS PDP Region 03).

5 of 10 stand-alone Part D plans in New York cover this drug on tier 5.

5 of 5 plans apply a prior authorization, step therapy or quantity limit.

86 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: 86 plans.

Every plan that covers it

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$35.70/mo premium · $615.00 deductible5Specialty Tier25%—$255.2739$765.823 units
  • Prior authorization
  • Quantity limit 3 per 30 days
Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible5Specialty Tier25%—$254.8903$764.673 units
  • Prior authorization
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible5Specialty Tier25%—$254.8903$764.673 units
  • Prior authorization
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible5Specialty Tier25%—$255.3019$765.913 units
  • Prior authorization
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible5Specialty Tier31%—$281.9353$845.813 units
  • Prior authorization
  • Quantity limit 3 per 30 days

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.

See coverage in all 39 regions →