MedicarePartD.guide

A non-government resource built from CMS public data

NAPROXEN ORAL SUSPENSION 125 mg/5mL Suspension

Also known as Naproxen Oral. Package: 500 mL in 1 BOTTLE (70954-151-10). NDC 70954015110.

Plans covering it
99
across 39 regions checked
Lowest tier
4
lower tiers cost less
Plans with restrictions
39
prior auth, step therapy or quantity limit

Medicare Advantage plans in your county

Medicare Advantage drug plans in 49 states list this drug on their own formularies. Enter a ZIP code or choose a state to see every plan in a county, with its tier, cost-sharing and restrictions.

Coverage by region

Covered by at least one plan in 35 of 39 CMS regions; no plan covers it in 4.

RegionPlans coveringTiersLowest 30-day costRestrictions
New Jersey4 of 124—2 of 4 plans
North Carolina4 of 124—2 of 4 plans
Illinois4 of 124—2 of 4 plans
Texas4 of 124—2 of 4 plans
New York3 of 104—1 of 3 plans
Delaware, DC and Maryland3 of 104—1 of 3 plans
Pennsylvania and West Virginia3 of 124—1 of 3 plans
South Carolina3 of 114—1 of 3 plans
Georgia3 of 104—1 of 3 plans
Alabama and Tennessee3 of 124—1 of 3 plans
Michigan3 of 124—1 of 3 plans
Ohio3 of 104—1 of 3 plans
Indiana and Kentucky3 of 104—1 of 3 plans
Wisconsin3 of 104—1 of 3 plans
Missouri3 of 104—1 of 3 plans
Arkansas3 of 124—1 of 3 plans
Mississippi3 of 104—1 of 3 plans
Louisiana3 of 104—1 of 3 plans
Oklahoma3 of 114—1 of 3 plans
Kansas3 of 124—2 of 3 plans
Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming3 of 114—1 of 3 plans
Colorado3 of 104—1 of 3 plans
Arizona3 of 104—1 of 3 plans
Nevada3 of 104—1 of 3 plans
Oregon and Washington3 of 104—1 of 3 plans
Idaho and Utah3 of 104—1 of 3 plans
California3 of 124—1 of 3 plans
Maine and New Hampshire2 of 94—1 of 2 plans
Connecticut, Massachusetts, Rhode Island and Vermont2 of 114—1 of 2 plans
Virginia2 of 94—1 of 2 plans
New Mexico2 of 114—1 of 2 plans
Alaska2 of 94—1 of 2 plans
Puerto Rico2 of 34—none
Florida1 of 104—1 of 1 plans
Hawaii1 of 84—1 of 1 plans
American Samoano PDP———
Guamno PDP———
Northern Mariana Islandsno PDP———
U.S. Virgin Islandsno PDP———

Plan-by-plan detail

Open a region to see every plan that covers this drug, with tier, cost-sharing and restrictions.

New Jersey — 4 plans, 2 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 4 of 4 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.4815—None
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.3508$6.3118 units
  • Prior authorization
  • Quantity limit 18 per 30 days
HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible4Non-Preferred Drug27%27%$0.4873—None
Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible4Non-Preferred Drug45%45%$0.6233$11.2218 units
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

North Carolina — 4 plans, 2 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 4 of 4 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible4Non-Preferred Drug31%31%$0.6590—None
SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.4235$7.6218 units
  • Prior authorization
  • Quantity limit 18 per 30 days
HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible4Non-Preferred Drug32%32%$0.4822—None
Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible4Non-Preferred Drug40%40%$0.5611$10.1018 units
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Illinois — 4 plans, 2 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 4 of 4 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.5028—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.3187$5.7418 units
  • Prior authorization
  • Quantity limit 18 per 30 days
HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible4Non-Preferred Drug32%32%$0.4592—None
Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible4Non-Preferred Drug32%32%$0.4959$8.9318 units
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Texas — 4 plans, 2 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 4 of 4 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Extra Rx (PDP)$70.00/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.4751—None
SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.3402$6.1218 units
  • Prior authorization
  • Quantity limit 18 per 30 days
HealthSpring Assurance Rx (PDP)$111.40/mo premium · $615.00 deductible4Non-Preferred Drug31%31%$0.4901—None
Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible4Non-Preferred Drug32%32%$0.5327$9.5918 units
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

New York — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$35.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug29%29%$0.4781—None
HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible4Non-Preferred Drug29%29%$0.4854—None
SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.3161$5.6918 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Delaware, DC and Maryland — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.4526—None
HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible4Non-Preferred Drug32%32%$0.4527—None
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.3221$5.8018 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Pennsylvania and West Virginia — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug35%35%$0.5321$9.5818 units
  • Prior authorization
  • Quantity limit 18 per 30 days
HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible4Non-Preferred Drug31%31%$0.4598—None
HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible4Non-Preferred Drug31%31%$0.3910—None

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 — elsewhere it depends on what is prescribed.

South Carolina — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.4737—None
SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.5342$9.6218 units
  • Prior authorization
  • Quantity limit 18 per 30 days
HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible4Non-Preferred Drug31%31%$0.4149—None

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 — elsewhere it depends on what is prescribed.

Georgia — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.4877—None
SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.3419$6.1518 units
  • Prior authorization
  • Quantity limit 18 per 30 days
HealthSpring Assurance Rx (PDP)$149.30/mo premium · $615.00 deductible4Non-Preferred Drug31%31%$0.4895—None

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 — elsewhere it depends on what is prescribed.

Alabama and Tennessee — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible4Non-Preferred Drug31%31%$0.6166—None
HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible4Non-Preferred Drug32%32%$0.5362—None
SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.3941$7.0918 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Michigan — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug30%30%$0.5313—None
HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible4Non-Preferred Drug32%32%$0.5149—None
SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.3217$5.7918 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Ohio — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.5584—None
SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.4174$7.5118 units
  • Prior authorization
  • Quantity limit 18 per 30 days
HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.4722—None

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 — elsewhere it depends on what is prescribed.

Indiana and Kentucky — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug35%35%$0.4213$7.5818 units
  • Prior authorization
  • Quantity limit 18 per 30 days
HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.8287—None
HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.4537—None

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 — elsewhere it depends on what is prescribed.

Wisconsin — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug30%30%$0.5079—None
SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible4Non-Preferred Drug35%35%$0.3562$6.4118 units
  • Prior authorization
  • Quantity limit 18 per 30 days
HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.9093—None

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 — elsewhere it depends on what is prescribed.

Missouri — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.5604—None
HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.4670—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.3640$6.5518 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Arkansas — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug29%29%$0.4700—None
HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible4Non-Preferred Drug31%31%$0.4600—None
SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.3054$5.5018 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Mississippi — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.8952—None
HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.9526—None
SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.3567$6.4218 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Louisiana — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible4Non-Preferred Drug35%35%$0.5040$9.0718 units
  • Prior authorization
  • Quantity limit 18 per 30 days
HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.5353—None
HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.6148—None

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 — elsewhere it depends on what is prescribed.

Oklahoma — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.9335—None
HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible4Non-Preferred Drug29%29%$0.4712—None
Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible4Non-Preferred Drug32%32%$0.4727$8.5118 units
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Kansas — 3 plans, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$6.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug31%31%$0.5128—None
Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible4Non-Preferred Drug40%40%$0.6615$11.9118 units
  • Quantity limit 18 per 30 days
SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.3054$5.5018 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug35%35%$0.4437$7.9918 units
  • Prior authorization
  • Quantity limit 18 per 30 days
HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible4Non-Preferred Drug31%31%$0.5642—None
HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.5540—None

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 — elsewhere it depends on what is prescribed.

Colorado — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.8440—None
HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible4Non-Preferred Drug31%31%$0.9653—None
SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.4612$8.3018 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Arizona — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug29%29%$0.5036—None
HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible4Non-Preferred Drug31%31%$0.9671—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.3860$6.9518 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Nevada — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.5059—None
HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.5128—None
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.0901$19.6218 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Oregon and Washington — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug30%30%$0.4899—None
HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.8773—None
SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.3097$5.5718 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Idaho and Utah — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug35%35%$0.4345$7.8218 units
  • Prior authorization
  • Quantity limit 18 per 30 days
HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible4Non-Preferred Drug31%31%$0.9193—None
HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.6769—None

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 — elsewhere it depends on what is prescribed.

California — 3 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug29%29%$0.4661—None
HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible4Non-Preferred Drug30%30%$0.5126—None
SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.3367$6.0618 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Maine and New Hampshire — 2 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 2 of 2 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug30%30%$0.7916—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.4455$8.0218 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Connecticut, Massachusetts, Rhode Island and Vermont — 2 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 2 of 2 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug35%35%$0.5107$9.1918 units
  • Prior authorization
  • Quantity limit 18 per 30 days
HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible4Non-Preferred Drug31%31%$0.4653—None

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 — elsewhere it depends on what is prescribed.

Virginia — 2 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 2 of 2 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.5017$9.0318 units
  • Prior authorization
  • Quantity limit 18 per 30 days
HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible4Non-Preferred Drug31%31%$0.3482—None

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 — elsewhere it depends on what is prescribed.

New Mexico — 2 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 2 of 2 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug29%29%$1.0000—None
SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.5307$9.5518 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Alaska — 2 plans, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 2 of 2 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug29%29%$0.7454—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.4259$7.6718 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Puerto Rico — 2 plans
Prior authorization
Step therapy
Quantity limit

Showing 2 of 2 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible4Non-Preferred Drug31%31%$1.0800—None
HealthSpring Assurance Rx (PDP)$65.70/mo premium · $615.00 deductible4Non-Preferred Drug34%34%$0.5200—None

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 — elsewhere it depends on what is prescribed.

Florida — 1 plan, 1 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 1 of 1 plan

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.3089$5.5618 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

Hawaii — 1 plan, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 1 of 1 plan

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug35%35%$0.7350$13.2318 units
  • Prior authorization
  • Quantity limit 18 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 — elsewhere it depends on what is prescribed.

No stand-alone Part D plan in American Samoa

None of the 1 stand-alone Part D plans in CMS PDP Region 35 list this drug on their formulary. The patient would pay the full retail price, or you would need a formulary exception. It is on a Part D formulary elsewhere in the country.

No stand-alone Part D plan in Guam

None of the 1 stand-alone Part D plans in CMS PDP Region 36 list this drug on their formulary. The patient would pay the full retail price, or you would need a formulary exception. It is on a Part D formulary elsewhere in the country.

No stand-alone Part D plan in Northern Mariana Islands

None of the 1 stand-alone Part D plans in CMS PDP Region 37 list this drug on their formulary. The patient would pay the full retail price, or you would need a formulary exception. It is on a Part D formulary elsewhere in the country.

No stand-alone Part D plan in U.S. Virgin Islands

None of the 1 stand-alone Part D plans in CMS PDP Region 39 list this drug on their formulary. The patient would pay the full retail price, or you would need a formulary exception. It is on a Part D formulary elsewhere in the country.