Medicare Advantage Drug Cost for Orencia



There are 31 Medicare Advantage Plans with additional prescription drug coverage for Orencia available to residents in Ohio. The average retail unit cost (e.g. per pill) for a 30-day supply at in-area retail pharmacies is $1,868.98 ($56,069.46). Orencia 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 Orencia in Ohio. 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 Cuyahoga with the best coverage and the cheapest prices for your medications in Ohio.



Proprietary Name:Orencia
Generic Name:Abatacept
Drug Package:4 Syringe, Glass In 1 Carton > .7 Ml In 1 Syringe, Glass
Drug Strength:87.5mg/.7mL
Substance:Abatacept
Dosage Form:Injection, Solution
Route:Subcutaneous
Labeler:E.r. Squibb & Sons, L.l.c.
Pen Name:Human Prescription Drug
NDC#00003281811
RX#1925257
Days Supply:30
Coverage Phase:Initial Coverage
Plan Year:2023
County:Cuyahoga





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Medicare Advantage Coverage for Orencia in Ohio


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$1,931.71
($57,951.17)
AARP Medicare Advantage Flex Plan 8

5NA33%33%/YN$1,938.29
($58,148.80)
AARP Medicare Advantage Plan 1

5NA33%33%/YN$1,938.29
($58,148.80)
AARP Medicare Advantage Plan 3

5NA33%33%/YN$1,938.29
($58,148.80)
AARP Medicare Advantage Plan 7

5NA33%33%/YN$1,938.29
($58,148.80)
MedMutual Advantage Access

533%33%33%/YN$1,814.00
($54,420.04)
MedMutual Advantage Choice

532%32%32%/YN$1,814.00
($54,420.04)
MedMutual Advantage Classic

531%31%31%/YN$1,814.00
($54,420.04)
MedMutual Advantage Plus

532%32%32%/YN$1,814.00
($54,420.04)
MedMutual Advantage Preferred

532%32%32%/YN$1,814.00
($54,420.04)
MedMutual Advantage Premium

532%32%32%/YN$1,814.00
($54,420.04)
MedMutual Advantage Secure

531%31%31%/YN$1,814.00
($54,420.04)
MedMutual Advantage Select

531%31%31%/YN$1,814.00
($54,420.04)
MedMutual Advantage Signature

533%33%33%/YN$1,814.00
($54,420.04)
SummaCare Medicare Emerald

5NA33%NA/YN$1,824.03
($54,720.96)
SummaCare Medicare Garnet

5NA33%NA/YN$1,824.03
($54,720.96)
SummaCare Medicare Ruby

5NA33%NA/YN$1,824.03
($54,720.96)
SummaCare Medicare Sapphire

5NA33%NA/YN$1,824.03
($54,720.96)
SummaCare Medicare Topaz

5NA33%NA/YN$1,824.03
($54,720.96)
The Health Plan SecureCare - Option II

531%31%31%/YN$1,814.05
($54,421.45)
The Health Plan SecureChoice - Option II

531%31%31%/YN$1,814.05
($54,421.45)


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SNP Prescription Drug Cost for Orencia

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)
CareSource Dual Advantage

5NA25%NA/YN$1,809.32
($54,279.61)
Perennial Advantage Concierge

5NA25%NA/YN$2,027.87
($60,836.13)
Perennial Advantage Strive

1NA25%NA/YN$2,027.20
($60,816.13)
The Health Plan SecureCare SNP

1NA15%NA/YN$1,814.11
($54,423.35)
UnitedHealthcare Assisted Living Plan

5NA33%33%/YN$1,938.29
($58,148.80)
UnitedHealthcare Dual Complete LP

5NA15%NA/YN$1,938.29
($58,148.80)
UnitedHealthcare Nursing Home Plan 1

5NA25%NA/YN$1,938.29
($58,148.80)
UnitedHealthcare Nursing Home Plan 2

5NA25%NA/YN$1,938.29
($58,148.80)


Do any Medicare Advantage Plans Cover Orencia? Yes, 31 Medicare Advantage Plans cover this drug in Ohio.

How much does Orencia Cost? $1,868.98, the average retail cost in Ohio is $1,868.98 per unit or $56,069.46 for a 30-day supply at in-area pharmacies.

What Tier is Orencia? Tier 5, most Advantage Plans list Orencia 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 Orencia? Yes, the majority of Medicare Prescription Plans do require prior authorization from your doctor for Orencia.



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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*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.

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