Medicare Advantage Drug Cost for Kalydeco



There are 27 Medicare Advantage Plans with additional prescription drug coverage for Kalydeco available to residents in Kentucky. The average retail unit cost (e.g. per pill) for a 30-day supply at in-area retail pharmacies is $477.53 ($14,325.79). Kalydeco is typically listed as a Tier 5 drug on the formulary and does not require prior authorization.

Below is the average retail cost and your co-pay for Kalydeco in Kentucky. 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 Jefferson with the best coverage and the cheapest prices for your medications in Kentucky.



Proprietary Name:Kalydeco
Generic Name:Ivacaftor
Drug Package:56 Granule In 1 Carton
Drug Strength:25mg/1
Substance:Ivacaftor
Dosage Form:Granule
Route:Oral
Labeler:Vertex Pharmaceuticals Incorporated
Pen Name:Human Prescription Drug
NDC#51167060001
RX#2166401
Days Supply:30
Coverage Phase:Initial Coverage
Plan Year:2023
County:Jefferson





Select Another State:


Select Another County:

Medicare Advantage Coverage for Kalydeco in Kentucky


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 Choice

5NA33%33%/YN$479.28
($14,378.44)
AARP Medicare Advantage Flex Plan 1

5NA33%33%/YN$479.28
($14,378.44)
AARP Medicare Advantage Flex Plan 2

5NA33%33%/YN$479.28
($14,378.44)
Aetna Medicare Premier

533%33%33%/YN$494.49
($14,834.66)
Aetna Medicare Value Plan

533%33%33%/YN$494.49
($14,834.66)
Humana Community

5NA33%33%/YN$464.31
($13,929.27)
Humana Gold Plus H5619-071

5NA33%33%/YN$464.31
($13,929.27)
HumanaChoice H5216-019

5NA33%33%/YN$464.31
($13,929.27)
HumanaChoice H5216-107

5NA29%29%/YN$464.31
($13,929.27)
HumanaChoice H5216-188

5NA33%33%/YN$464.31
($13,929.27)
HumanaChoice H5216-226

5NA33%33%/YN$464.31
($13,929.27)
HumanaChoice R0865-003

5NA30%30%/YN$464.31
($13,929.27)
Passport Medicare Choice Care

5NA31%NA/YN$474.99
($14,249.66)
Wellcare Assist

525%25%25%/YN$491.72
($14,751.70)
Wellcare Giveback

533%33%33%/YN$496.95
($14,908.40)
Wellcare No Premium

533%33%33%/YN$496.95
($14,908.40)
Wellcare No Premium Essential

533%33%33%/YN$496.95
($14,908.40)
Wellcare No Premium Open

531%31%31%/YN$496.95
($14,908.40)


Return to Drug List



SNP Prescription Drug Cost for Kalydeco

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)
Aetna Medicare Assure 1

5NA$0NA/YN$494.49
($14,834.66)
Humana Community HMO Diabetes and Heart

5NA33%33%/YN$464.31
($13,929.27)
Humana Community HMO SNP-DE

5NA$0NA/YN$464.31
($13,929.27)
Humana Gold Plus SNP-DE H5619-075

5NA$0NA/YN$464.31
($13,929.27)
Passport Advantage

5NA25%NA/YN$474.99
($14,249.66)
Signature Advantage Community

1NA25%NA/YN$457.94
($13,738.19)
Signature Advantage Plan

1NA25%NA/YN$457.94
($13,738.19)
Wellcare Dual Access

1NA$0NA/YN$491.72
($14,751.70)
Wellcare Dual Liberty

1NA$0NA/YN$491.72
($14,751.70)


Do any Medicare Advantage Plans Cover Kalydeco? Yes, 27 Medicare Advantage Plans cover this drug in Kentucky.

How much does Kalydeco Cost? $477.53, the average retail cost in Kentucky is $477.53 per unit or $14,325.79 for a 30-day supply at in-area pharmacies.

What Tier is Kalydeco? Tier 5, most Advantage Plans list Kalydeco on Tier 5 on their formulary. Usually, the higher the tier, the more you have to pay for the medication.

Do I need Prior Authorization for Kalydeco? Yes, the majority of Medicare Prescription Plans do require prior authorization from your doctor for Kalydeco.



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:

MedicareHelp.org is a privately-owned Non-governmental agency. The government website can be found at HealthCare.gov.

Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.

Every year, Medicare evaluates plans based on a 5-star rating system.