COLISTIMETHATE 150 mg Injection, Powder, For Solution
Also known as Colistimethate Sodium. Coverage in South Carolina (CMS PDP Region 09).
11 of 11 stand-alone Part D plans in South Carolina cover this drug on tier 4–5.
5 of 11 plans apply a prior authorization, step therapy or quantity limit.
Every plan that covers it
Showing 11 of 11 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$4.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.3404 | $129.069 units |
|
| Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $14.3404 | $129.069 units |
|
| Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 30% | — | $13.2000 | — | None |
| Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $13.2000 | — | None |
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $13.1033 | — |
|
| SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $15.3323 | — |
|
| AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible | 4Non-Preferred Drug | 36% | — | $16.3132 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 4Non-Preferred Drug | 35% | — | $16.3562 | — | None |
| BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 50% | 50% | $16.3277 | — | None |
| Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $13.2000 | — | None |
| HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $13.1033 | — |
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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.
80 Medicare Advantage plans in SC do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. SC: 80 plans.