AUGMENTIN 125/31.25 mg/5mL For Suspension
Also known as Amoxicillin And Clavulanate Potassium. Coverage in New York (CMS PDP Region 03).
1 of 10 stand-alone Part D plans in New York cover this drug on tier 5.
No plan applies a prior authorization, step therapy or quantity limit.
4 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: 4 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $5.3788 | — | 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.