Medicare Advantage Drug Cost for Amikacin Sulfate



There are 58 Medicare Advantage Plans with additional prescription drug coverage for Amikacin Sulfate available to residents in Arizona. The average retail unit cost (e.g. per pill) for a 30-day supply at in-area retail pharmacies is $4.68 ($140.38). Amikacin Sulfate is typically listed as a Tier 4 drug on the formulary and does not require prior authorization.

Below is the average retail cost and your co-pay for Amikacin Sulfate in Arizona. You can also see if each plan requires prior authorization, step therapy or has drug quantity limits. Please check the formulary for different brand and generic drug names. Every Medicare Advantage Plan will vary in coverage, co-pays, costs and premiums. This chart can help you sort through different plan details to find a Medicare Advantage Plan in Maricopa with the best coverage and the cheapest prices for your medications in Arizona.



Proprietary Name:Amikacin Sulfate
Generic Name:Amikacin Sulfate
Drug Package:10 Vial, Glass In 1 Carton
Drug Strength:250mg/mL
Substance:Amikacin Sulfate
Dosage Form:Injection, Solution
Route:Intramuscular; Intravenous
Labeler:Heritage Pharmaceuticals Inc. D/b/a Avet Pharmaceu
Pen Name:Human Prescription Drug
NDC#23155029041
RX#1723156
Days Supply:30
Coverage Phase:Initial Coverage
Plan Year:2023
County:Maricopa





Select Another State:


Select Another County:

Medicare Advantage Coverage for Amikacin Sulfate in Arizona


Click the Plan Name for More Details
Click the header to sort
Plan
Name ⇅
Tier
Level
Your
Cost
Preferred
Cost
Non
Preferred
Cost
Mail
Limit
Amt/
Days
Prior
Auth
Y/N
Step
Therapy
Y/N
Avg
Unit
Cost
(x30)
AARP Medicare Advantage Plan 1

4NA$95NA/NN$4.20
($126.13)
AARP Medicare Advantage Plan 2

4NA$95NA/NN$4.20
($126.13)
AARP Medicare Advantage Plan 3

4NA$95NA/NN$4.20
($126.13)
AARP Medicare Advantage Plan 4

4NA$95NA/NN$4.20
($126.13)
AARP Medicare Advantage Walgreens Plan 1

4$100$100NA/NN$4.24
($127.11)
AARP Medicare Advantage Walgreens Plan 2

4$100$100NA/NN$4.24
($127.11)
AARP Medicare Advantage Walgreens Plan 3

4$100$100NA/NN$4.24
($127.11)
Aetna Medicare Freedom Plan

4$100$100$100/NN$2.39
($71.61)
Aetna Medicare Platinum Plan

4$100$100$100/NN$2.39
($71.61)
Aetna Medicare Platinum Plan

4$100$100$100/NN$2.39
($71.61)
Aetna Medicare Premier Plan

4$100$100$100/NN$2.43
($72.93)
Aetna Medicare Prime Plan

4$100$100$100/NN$2.43
($72.93)
Aetna Medicare Prime Plus Plan

4$100$100$100/NN$2.43
($72.93)
Alignment Health AVA

4NA$100NA/NN$5.06
($151.68)
Alignment Health the ONE

4NA$100NA/NN$5.05
($151.38)
Amerivantage Plus

2$7.5$12.5NA/NN$2.82
($84.72)
Banner Medicare Advantage Plus

4NA$100NA/YN$4.27
($128.13)
Banner Medicare Advantage Prime

4NA$100NA/YN$4.27
($128.13)
Cigna Alliance Medicare

4$100$100$100/YN$5.91
($177.24)
Cigna Preferred Medicare

4$100$100$100/YN$5.91
($177.24)
Devoted CORE Arizona

2NA$5NA/NN$5.51
($165.44)
Devoted SELECT Arizona

2NA$5NA/NN$5.51
($165.44)
Humana Gold Plus H0028-023

4NA$100$100/NN$5.51
($165.24)
Humana Gold Plus H0028-027

4NA$100$100/NN$5.51
($165.24)
Humana Gold Plus H0028-028

4NA$100$100/NN$5.51
($165.24)
Humana Gold Plus H0028-052

4NA$100$100/NN$5.51
($165.24)
Humana Value Plus H5216-197

4NA25%25%/NN$5.51
($165.25)
HumanaChoice H5216-034

4NA$100$100/NN$5.51
($165.25)
HumanaChoice H5216-137

4NA$99$99/NN$5.51
($165.30)
HumanaChoice H5216-224

4NA$100$100/NN$5.51
($165.25)
HumanaChoice H5216-265

4NA$100$100/NN$5.51
($165.24)
HumanaChoice R7220-002

4NA24%24%/NN$5.51
($165.25)
Imperial Insurance Company Traditional

4NA$90NA/YN$5.79
($173.64)
Imperial Insurance Traditional Plus

4NA25%NA/YN$5.79
($173.64)
SCAN Classic

2$0$15$0/NN$4.27
($128.21)
SCAN Venture

2$0$20$0/NN$4.27
($128.21)
Wellcare No Premium Essentials

4$90$100$90/NN$5.51
($165.44)
Wellcare No Premium Open

4$90$100$90/NN$5.51
($165.44)


Return to Drug List



SNP Prescription Drug Cost for Amikacin Sulfate

Click the Plan Name for More Details about that Plan
Click the header to sort
Plan
Name ⇅
Tier
Level
Cost
Preferred
Cost
Non
Preferred
Cost
Amt
Mail
Limit
Days/
Amt
Prior
Auth
Y/N
Step
Therapy
Y/N
Avg
Unit
Cost
(x30)
Alignment Health Heart & Diabetes

4NA$100NA/NN$5.06
($151.68)
Amerivantage Comfort

2NA$7.5NA/NN$3.78
($113.39)
Amerivantage Comfort Plus

2NA$7.5NA/NN$3.78
($113.39)
Banner Medicare Advantage Dual

4NA$0NA/YN$4.25
($127.57)
Banner Medicare Advantage Dual

4NA$0NA/YN$4.25
($127.57)
BCBSAZ Health Choice Pathway

1NA15%NA/NN$5.51
($165.44)
Cigna Achieve Medicare

4$100$100$100/YN$5.91
($177.24)
Imperial Insurance Value

4NA$90NA/YN$5.79
($173.64)
Mercy Care Advantage

1NA$0NA/NN$5.51
($165.44)
Mercy Care Advantage

1NA$0NA/NN$5.51
($165.44)
Mercy Care Advantage

1NA$0NA/NN$5.51
($165.44)
Molina Medicare Complete Care

1NA$0NA/NN$5.51
($165.44)
SCAN Balance

2$0$9$0/NN$4.27
($128.21)
SCAN Heart First

2$0$9$0/NN$4.27
($128.21)
UnitedHealthcare Chronic Complete

4NA$95NA/NN$4.20
($126.13)
UnitedHealthcare Dual Complete LP

4NA15%NA/NN$4.25
($127.56)
UnitedHealthcare Dual Complete ONE

4NA15%NA/NN$4.20
($126.13)
UnitedHealthcare Nursing Home Plan

4NA25%NA/NN$4.25
($127.56)
Wellcare Dual Liberty

1NA$0NA/NN$5.51
($165.44)
Wellcare Specialty No Premium

2$5$10$5/NN$5.51
($165.44)


Do any Medicare Advantage Plans Cover Amikacin Sulfate? Yes, 58 Medicare Advantage Plans cover this drug in Arizona.

How much does Amikacin Sulfate Cost? $4.68, the average retail cost in Arizona is $4.68 per unit or $140.38 for a 30-day supply at in-area pharmacies.

What Tier is Amikacin Sulfate? Tier 4, most Advantage Plans list Amikacin Sulfate on Tier 4 on their formulary. Usually, the higher the tier, the more you have to pay for the medication.

Do I need Prior Authorization for Amikacin Sulfate? No, the majority of Medicare Prescription Plans do not require prior authorization from your doctor for Amikacin Sulfate.



Additional Notes by Medicare Help:

Most plans have 4 levels of coverage. The exception is the $0 Deductible Plans.
1.Pre-Deductable: Before you reach the plans deductible. Some plans offer select Pre-deductible drug Coverage
2.Initial Coverage: (ICL) After you reach the plans deductible but before the Initial Coverage limit.
3.Coverage Gap: (AKA Donut Hole) After you reach the plans ICL but before the Catastrophic of $7550 in 2022.
4.Catastrophic: Anything over $7550 you will receive a significant increase in coverage.

Formulary Definitions:

Tier Level: Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost. A drug in a lower tier will generally cost you less.
Cost Preferred: Your Cost for the Drug at the Providers In Network Preferred Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Non Preferred: Your Cost for the Prescription Drug at a Non-Preferred Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Mail: Your Cost for Prescription Drugs through a Mail Order Pharmacy. As a Percent of the total drug cost or a flat rate.
Quantity Limit Amount/Days: Certain drugs have a Quantity Limit. That means the plan will only cover the drug up to a designated quantity or amount. If your prescribing doctor feels it is necessary to exceed the set limit, he or she must get prior approval before the higher quantity will be covered.
Prior Authorization: Certain Drugs require you or your doctor to get prior authorization in order to be covered. Usually just an additional form. If you dont get approval, the plan may not cover the drug.
Step Therapy: Means you must first try one drug to treat your medical condition before the plan will cover another drug for the same condition. If you have already tried other drugs or your doctor thinks they are not right for you, you and your doctor can ask the plan to cover this drug.
Avg Unit Cost: Average unit cost (e.g. per pill) for specified days supply at in-area retail pharmacies. A pharmacy is considered in-area when it is geographically located in the service area.




What if a drug I need is not listed?

Please check the formulary for different brand and generic names. If you still cannot locate your drugs, your plan may not offer coverage. Talk to your doctor first about changing your prescription to a drug on your plans formulary. If this is not an option, you can request an exception to have the plan review its coverage decision based on your individual circumstances.

Last updated on
Source:CMS Formulary Data Q4 2022
Source:NDC Directory by FDA.gov

**We make every attempt to keep our information accurate. But please check with the plan providers to verify all information.

      Site Search:

*Licensed Agent Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

Call For A licensed Sales Agent

Or Enroll Online Here

Enroll