ERYTHROMYCIN 250 mg Capsule, Delayed Release Pellets
Coverage in Ohio (CMS PDP Region 14).
10 of 10 stand-alone Part D plans in Ohio cover this drug on tier 4.
No plan applies a prior authorization, step therapy or quantity limit.
172 Medicare Advantage plans in OH 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. OH: 172 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)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | — | $9.8071 | — | None |
| Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $6.1472 | — | None |
| Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $6.1099 | — | None |
| Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $9.8473 | — | None |
| HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $6.0412 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | — | $6.3986 | — | None |
| SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $6.8986 | — | None |
| HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $6.2137 | — | None |
| Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $9.7845 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible | 4Non-Preferred Drug | 36% | — | $6.3745 | — | 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.