Medicare Advantage Drug Cost for Neomycin And Polymyxin B Sulfates And Gramicidin



There are 78 Medicare Advantage Plans with additional prescription drug coverage for Neomycin And Polymyxin B Sulfates And Gramicidin available to residents in New York. The average retail unit cost (e.g. per pill) for a 30-day supply at in-area retail pharmacies is $4.48 ($134.28). Neomycin And Polymyxin B Sulfates And Gramicidin is typically listed as a Tier 3 drug on the formulary and does not require prior authorization.

Below is the average retail cost and your co-pay for Neomycin And Polymyxin B Sulfates And Gramicidin in New York. 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 Bronx with the best coverage and the cheapest prices for your medications in New York.



Proprietary Name:Neomycin And Polymyxin B Sulfates And Gramicidin
Generic Name:Neomycin Sulfate, Polymyxin B Sulfate And Gramicid
Drug Package:1 Bottle, Dropper In 1 Carton > 10 Ml In 1 Bottle, Dropper
Drug Strength:.025; 1.75; 10000mg/mL; mg/mL; [USP'U]/mL
Substance:Gramicidin; Neomycin Sulfate; Polymyxin B Sulfate
Dosage Form:Solution/ Drops
Route:Ophthalmic
Labeler:Bausch & Lomb Incorporated
Pen Name:Human Prescription Drug
NDC#24208079062
RX#310594
Days Supply:30
Coverage Phase:Initial Coverage
Plan Year:2023
County:Bronx





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Medicare Advantage Coverage for Neomycin And Polymyxin B Sulfates And Gramicidin in New York


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

3NA$47NA/NN$4.29
($128.72)
AARP Medicare Advantage Plan 2

3NA$47NA/NN$4.29
($128.72)
Aetna Medicare Elite Plan

2$0$20$0/NN$4.85
($145.57)
Aetna Medicare Premier Plan

2$5$20$5/NN$4.89
($146.59)
Aetna Medicare Value Plan

2$5$20$5/NN$4.85
($145.42)
AgeWell New York LiveWell

2NA$15NA/NN$5.16
($154.86)
Centers Plan for Medicare Advantage Care

2NA$15NA/NN$4.62
($138.47)
Elderplan Extra Help

3NA$47NA/NN$4.59
($137.84)
EmblemHealth VIP Gold

3$40$47$40/NN$4.06
($121.89)
EmblemHealth VIP Gold Plus

3$40$47$40/NN$4.30
($129.02)
Empire MediBlue Extra Select

3$47$47NA/NN$4.59
($137.84)
Empire MediBlue HealthPlus

3$42$47NA/NN$4.59
($137.84)
Empire MediBlue HealthPlus Select

3$35$35NA/NN$4.59
($137.84)
Empire MediBlue Plus

3$42$47NA/NN$4.59
($137.84)
Empire MediBlue Select

3$42$47NA/NN$4.59
($137.84)
Healthfirst 65 Plus Plan

3NA$47NA/NN$4.59
($137.84)
Healthfirst Increased Benefits Plan

3NA$47NA/NN$4.59
($137.84)
Healthfirst Signature

3NA$47NA/NN$4.59
($137.84)
Humana Gold Plus H3533-027

3NA$47$47/NN$4.59
($137.73)
Humana Gold Plus H3533-032

3NA$47$47/NN$4.59
($137.68)
HumanaChoice H5970-024

3NA$47$47/NN$4.59
($137.73)
MetroPlus Platinum Plan

1NA25%NA/NN$4.59
($137.84)
UnitedHealthcare Medicare Advantage Choice Plan 1

3NA$47NA/NN$4.30
($129.00)
UnitedHealthcare Medicare Advantage Choice Plan 3

3NA$47NA/NN$4.30
($129.00)
UnitedHealthcare Medicare Advantage Choice Plan 4

3NA$47NA/NN$4.30
($129.00)
VNS Health EasyCare

2NA$20NA/NN$3.86
($115.91)
Wellcare Assist

3$47$47$47/NN$4.59
($137.84)
Wellcare Assist Open

3$47$47$47/NN$4.59
($137.84)
Wellcare Fidelis Assist

3$47$47$47/NN$3.98
($119.48)
Wellcare Fidelis No Premium

2$15$20$15/NN$3.74
($112.19)
Wellcare Giveback Open

3$37$47$37/NN$4.59
($137.84)
Wellcare No Premium

3$37$47$37/NN$4.59
($137.84)
Wellcare No Premium Open

3$37$47$37/NN$4.59
($137.84)
Wellcare Premium Ultra Open

3$35$45$35/NN$4.59
($137.84)


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SNP Prescription Drug Cost for Neomycin And Polymyxin B Sulfates And Gramicidin

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 Plan

2NA$0NA/NN$4.85
($145.57)
AgeWell New York Advantage Plus

2NA$0NA/NN$5.16
($154.86)
AgeWell New York CareWell

2NA25%NA/NN$5.16
($154.86)
AgeWell New York FeelWell

2NA$0NA/NN$5.16
($154.86)
ArchCare Advantage

1NA25%NA/NN$4.59
($137.84)
Centers Plan for Dual Coverage Care

1NA15%NA/NN$4.61
($138.26)
Centers Plan for Medicaid Advantage Plus

1NA$0NA/NN$4.61
($138.35)
Centers Plan for Nursing Home Care

1NA25%NA/NN$4.62
($138.68)
Elderplan Advantage For Nursing Home Residents

1NA25%NA/NN$4.59
($137.84)
Elderplan Assist

3NA$47NA/NN$4.59
($137.84)
Elderplan For Medicaid Beneficiaries

1NA15%NA/NN$4.59
($137.84)
Elderplan Plus Long Term Care

1NA15%NA/NN$4.59
($137.84)
EmblemHealth VIP Dual

3NA$47NA/NN$4.55
($136.46)
EmblemHealth VIP Dual Reserve

3NA$47NA/NN$3.96
($118.74)
Empire MediBlue Dual Advantage

3$47$47NA/NN$4.59
($137.84)
Empire MediBlue Dual Advantage Select

3$47$47NA/NN$4.59
($137.84)
Empire MediBlue HealthPlus Dual Connect

3$47$47NA/NN$4.59
($137.84)
Empire MediBlue HealthPlus Dual Plus

3$47$47NA/NN$4.59
($137.84)
Hamaspik Medicare Choice

1NA15%NA/NN$4.88
($146.28)
Hamaspik Medicare Select

1NA15%NA/NN$4.88
($146.32)
Healthfirst CompleteCare

3NA19%NA/NN$4.59
($137.84)
Healthfirst Life Improvement Plan

3NA16%NA/NN$4.59
($137.84)
Humana Gold Plus SNP-DE H3533-034

3NA$0NA/NN$4.59
($137.72)
HumanaChoice SNP-DE H5970-026

3NA$0NA/NN$4.59
($137.80)
Longevity Health Plan

1NA25%NA/NN$4.45
($133.40)
MetroPlus Advantage Plan

1NA$0NA/NN$4.59
($137.84)
MetroPlus UltraCare

1NA$0NA/NN$4.59
($137.84)
RiverSpring MAP

1NA15%NA/NN$3.14
($94.31)
RiverSpring Star

1NA25%NA/NN$3.14
($94.31)
Senior Whole Health of New York NHC

1NA$0NA/NN$4.59
($137.84)
UnitedHealthcare Assisted Living Plan

3NA$47NA/NN$4.30
($129.03)
UnitedHealthcare Dual Complete Plan 1

3NA$0NA/NN$4.30
($128.96)
UnitedHealthcare Dual Complete Plan 2

3NA$0NA/NN$4.30
($128.96)
UnitedHealthcare Nursing Home Plan 1

3NA25%NA/NN$4.30
($128.95)
UnitedHealthcare Nursing Home Plan 2

3NA25%NA/NN$4.30
($129.00)
VillageCareMAX Medicare Health Advantage

1NA15%NA/NN$4.29
($128.65)
VillageCareMAX Medicare Total Advantage

1NA$0NA/NN$4.29
($128.65)
VNS Health EasyCare Plus

1NA15%NA/NN$3.86
($115.91)
VNS Health Total

2NA$20NA/NN$3.86
($115.91)
Wellcare Dual Access

1NA$0NA/NN$4.59
($137.84)
Wellcare Dual Access Open

1NA$0NA/NN$4.59
($137.84)
Wellcare Fidelis Dual Access

1NA$0NA/NN$3.97
($119.21)
Wellcare Fidelis Dual Plus

1NA$0NA/NN$3.99
($119.84)


Do any Medicare Advantage Plans Cover Neomycin And Polymyxin B Sulfates And Gramicidin? Yes, 78 Medicare Advantage Plans cover this drug in New York.

How much does Neomycin And Polymyxin B Sulfates And Gramicidin Cost? $4.48, the average retail cost in New York is $4.48 per unit or $134.28 for a 30-day supply at in-area pharmacies.

What Tier is Neomycin And Polymyxin B Sulfates And Gramicidin? Tier 3, most Advantage Plans list Neomycin And Polymyxin B Sulfates And Gramicidin on Tier 3 on their formulary. Usually, the higher the tier, the more you have to pay for the medication.

Do I need Prior Authorization for Neomycin And Polymyxin B Sulfates And Gramicidin? No, the majority of Medicare Prescription Plans do not require prior authorization from your doctor for Neomycin And Polymyxin B Sulfates And Gramicidin.



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.

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