PERAMPANEL .5 mg/mL Suspension

Coverage in Pennsylvania and West Virginia (CMS PDP Region 06).

10 of 12 stand-alone Part D plans in Pennsylvania and West Virginia cover this drug on tier 4–5.

10 of 10 plans apply a prior authorization, step therapy or quantity limit.

322 Medicare Advantage plans in PA, WV 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. PA: 270 plans · WV: 52 plans.

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)$6.60/mo premium · $615.00 deductible	4Non-Preferred Drug	33%	—	$4.7422	$346.1873 units	Prior authorization Quantity limit 68 per 28 days
Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible	4Non-Preferred Drug	33%	—	$4.7422	$346.1873 units	Prior authorization Quantity limit 68 per 28 days
Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible	4Non-Preferred Drug	50%	50%	$4.7422	$346.1873 units	Prior authorization Quantity limit 68 per 28 days
Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$2.9225	$210.4272 units	Quantity limit 72 per 30 days
Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$2.9225	$210.4272 units	Quantity limit 72 per 30 days
SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$4.2458	$309.9473 units	Prior authorization Quantity limit 68 per 28 days
HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$2.8474	$205.0172 units	Quantity limit 72 per 30 days
HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$2.8565	$205.6772 units	Quantity limit 72 per 30 days
Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible	5Specialty Tier	25%	—	$2.8489	$2,051.21720 units	Quantity limit 744 per 31 days
Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible	5Specialty Tier	25%	25%	$2.8955	$2,084.76720 units	Quantity limit 744 per 31 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 →