VOQUEZNA TRIPLE PAK Kit
Also known as Vonoprazan Fumarate, Amoxicillin And Clarithromycin. Coverage in South Carolina (CMS PDP Region 09).
4 of 11 stand-alone Part D plans in South Carolina cover this drug on tier 4.
4 of 4 plans apply a prior authorization, step therapy or quantity limit.
41 Medicare Advantage plans in SC 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. SC: 41 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $7.7162 | $138.8918 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible | 4Non-Preferred Drug | 36% | — | $8.2802 | — |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 4Non-Preferred Drug | 35% | — | $8.2802 | — |
|
| BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 50% | 50% | $7.5369 | — |
|
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.