Clickable Table
Generic Name | Brand Name | Strength | Dosing | 90 Day Cost | Coverage | Comments | Category 1 | Category 2 |
---|---|---|---|---|---|---|---|---|
Fluticasone/Vilanterol | Breo Ellipta (30) | 100/25 mcg | 1 pf qd | $295 | BC / IA - SA |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
E Respiratory | Long-acting beta agonist/Corticosteroid Combos |
Budesonide/Formoterol | Symbicort (120) | 200/6 mcg | 1 pf bid | $160 | BC / IA - SA |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
E Respiratory | Long-acting beta agonist/Corticosteroid Combos |
Fluticasone/Salmeterol | Advair Diskus (60) | 250/50 mcg | 1 pf bid | $350 | BC / IA - SA |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
E Respiratory | Long-acting beta agonist/Corticosteroid Combos |
Fluticasone/Salmeterol | Advair MDI (120) | 250/25 mcg | 1 pf bid | $250 | BC / IA - SA |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
E Respiratory | Long-acting beta agonist/Corticosteroid Combos |
Ipratropium | Atrovent (200) | 200 mcg | 1 pf qid | $55 | BC / IA - Covered |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
E Respiratory | Bronchodilators / Anti-cholingergics |
Glycopyrronium | Seebri (30) | 50 mcg | 1 pf qd | $190 | BC - Covered / IA - NC |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
E Respiratory | Bronchodilators / Anti-cholingergics |
Tiotropium | Spiriva (30) | 18 mcg | 1 pf qd | $195 | BC / IA - Covered |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
E Respiratory | Bronchodilators / Anti-cholingergics |
Salbutamol | Ventolin (200) | 100 mcg | 4 pfs/d | $25 | BC / IA - Covered |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
E Respiratory | Bronchodilators / Anti-cholingergics |
Fluticasone | Flovent (120) | 125 mcg | 1 pf bid | $85 | BC / IA - Covered |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
E Respiratory | Corticosteroids |
Fluticasone | Flovent (120) | 250 mcg | 1 pf bid | $155 | BC / IA - Covered |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
E Respiratory | Corticosteroids |
Budesonide | Pulmicort (200) | 200 mcg | 1 pf bid | $80 | BC / IA - Covered |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
E Respiratory | Corticosteroids |
Beclomethasone | Qvar (200) | 100 mcg | 1 pf bid | $75 | BC / IA - Covered |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
E Respiratory | Corticosteroids |
Montelukast | Singulair | 10 mg | QD | $55 | BC / IA - SA |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
E Respiratory | Leukotriene Receptor Antagonist |
Glycopyrronium/Indacaterol | Ultibro (30) | 50/110 mcg | 1 pf qd | $275 | BC / IA - SA |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
E Respiratory | Long-acting Anti-cholinergic/Long-acting Beta-agonist Combos |