MOVANTIK 25 mg Tablet, Film Coated
Also known as Naloxegol Oxalate. Coverage in Indiana and Kentucky (CMS PDP Region 15).
10 of 10 stand-alone Part D plans in Indiana and Kentucky cover this drug on tier 3–4.
Lowest 30-day cost $45.00 at a preferred pharmacy. 10 of 10 plans apply a prior authorization, step therapy or quantity limit.
Every plan that covers it
Showing 10 of 10 plans
| 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 · $0 with full Extra Help | 3Preferred Brand | 25% | 20% | $14.6168 | $43.853 units |
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| Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $14.1595 | $42.483 units |
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| Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible · $0 with full Extra Help | 3Preferred Brand | 25% | 25% | $14.1595 | $42.483 units |
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| Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $14.6168 | $43.853 units |
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| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible · $0 with full Extra Help | 3Preferred Brand | 19% | 19% | $15.3944 | $46.183 units |
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| HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $14.2846 | $42.853 units |
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| AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $15.5896 | $46.773 units |
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| HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $14.3110 | $42.933 units |
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| Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $14.6168 | $43.853 units |
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| AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $15.5896 | $46.773 units |
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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.
Medicare Advantage plans
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D, and are sold county by county. Pick a county to see every Medicare Advantage drug plan there that covers this drug.
211 Medicare Advantage plans in IN, KY do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. IN: 111 plans · KY: 100 plans.