XCOPRI MAINTENANCE PACK Kit

Also known as Cenobamate. Coverage in Alaska (CMS PDP Region 34).

9 of 9 stand-alone Part D plans in Alaska cover this drug on tier 4–5.

9 of 9 plans apply a prior authorization, step therapy or quantity limit.

Every plan that covers it

Plan	Tier	30-day preferred	90-day mail	Unit cost	Est. 30-day fill	Restrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible	4Non-Preferred Drug	28%	—	$22.3709	$1,342.2560 units	Prior authorization Quantity limit 56 per 28 days
Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible	4Non-Preferred Drug	33%	—	$22.3709	$1,342.2560 units	Prior authorization Quantity limit 56 per 28 days
Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible	4Non-Preferred Drug	50%	50%	$22.3709	$1,342.2560 units	Prior authorization Quantity limit 56 per 28 days
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$21.3551	$1,281.3160 units	Quantity limit 56 per 28 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$21.3158	$1,278.9560 units	Prior authorization Quantity limit 56 per 28 days
Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$21.3551	$1,281.3160 units	Quantity limit 56 per 28 days
AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$23.2581	$1,395.4960 units	Prior authorization Quantity limit 56 per 28 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$23.2541	$1,395.2560 units	Quantity limit 56 per 28 days
AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible	5Specialty Tier	31%	—	$23.2581	$1,395.4960 units	Prior authorization Quantity limit 56 per 28 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 →