Medicare Advantage Drug Cost for Piqray



There are 53 Medicare Advantage Plans with additional prescription drug coverage for Piqray available to residents in Pennsylvania. The average retail unit cost (e.g. per pill) for a 30-day supply at in-area retail pharmacies is $347.15 ($10,414.48). Piqray 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 Piqray in Pennsylvania. 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 Allegheny with the best coverage and the cheapest prices for your medications in Pennsylvania.



Proprietary Name:Piqray
Generic Name:Alpelisib
Drug Package:2 Kit In 1 Carton * 14 Tablet In 1 Blister Pack * 14 Tablet In 1 Blister Pack
Drug Strength:
Substance:
Dosage Form:Kit
Route:
Labeler:Novartis Pharmaceuticals Corporation
Pen Name:Human Prescription Drug
NDC#00078071502
RX#2169320
Days Supply:30
Coverage Phase:Initial Coverage
Plan Year:2023
County:Allegheny





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Medicare Advantage Coverage for Piqray in Pennsylvania


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 Plan 1

5NA33%33%/YN$357.06
($10,711.66)
AARP Medicare Advantage Choice Plan 2

5NA33%33%/YN$357.06
($10,711.66)
AARP Medicare Advantage Flex Plan 1

5NA33%33%/YN$357.06
($10,711.66)
AARP Medicare Advantage Flex Plan 2

5NA33%33%/YN$357.06
($10,711.66)
Aetna Medicare Advantra Credit Value

533%33%33%/YN$376.11
($11,283.34)
Aetna Medicare Advantra Gold

533%33%33%/YN$376.11
($11,283.34)
Aetna Medicare Advantra Premier Plus

533%33%33%/YN$376.11
($11,283.34)
Aetna Medicare Advantra Silver

533%33%33%/YN$376.11
($11,283.34)
Aetna Medicare Gold Plan

533%33%33%/YN$376.11
($11,283.34)
Aetna Medicare Silver

533%33%33%/YN$376.11
($11,283.34)
Aetna Medicare Value

533%33%33%/YN$376.11
($11,283.34)
Community Blue Medicare HMO Prestige

533%33%33%/YN$333.87
($10,016.00)
Community Blue Medicare HMO Signature

533%33%33%/YN$334.80
($10,043.99)
Complete Blue PPO Distinct

533%33%33%/YN$327.19
($9,815.69)
Complete Blue PPO Signature

533%33%33%/YN$327.19
($9,815.69)
Freedom Blue PPO Classic

533%33%33%/YN$327.19
($9,815.69)
Freedom Blue PPO Select

533%33%33%/YN$327.19
($9,815.69)
Freedom Blue PPO ValueRx

533%33%33%/YN$327.19
($9,815.69)
Humana Value Plus H5216-117

5NA25%25%/YN$357.72
($10,731.71)
HumanaChoice H5216-120

5NA33%33%/YN$339.61
($10,188.17)
HumanaChoice H5525-017

5NA33%33%/YN$357.72
($10,731.71)
HumanaChoice H5525-051

5NA33%33%/YN$357.72
($10,731.71)
HumanaChoice R0923-002

5NA33%33%/YN$344.05
($10,321.61)
Security Blue HMO-POS Deluxe

5NA33%NA/YN$335.03
($10,050.86)
Security Blue HMO-POS Standard

5NA33%NA/YN$333.87
($10,016.00)
Security Blue HMO-POS ValueRx

533%33%33%/YN$333.87
($10,016.00)
UPMC for Life HMO Deductible Rx

533%33%33%/YN$326.61
($9,798.16)
UPMC for Life HMO Premier Rx

533%33%33%/YN$328.01
($9,840.40)
UPMC for Life HMO Rx

533%33%33%/YN$326.61
($9,798.16)
UPMC for Life HMO Rx Choice

533%33%33%/YN$326.61
($9,798.16)
UPMC for Life HMO Rx Enhanced

533%33%33%/YN$326.61
($9,798.16)
UPMC for Life PPO High Deductible Rx

533%33%33%/YN$328.01
($9,840.40)
UPMC for Life PPO Rx Enhanced

533%33%33%/YN$328.01
($9,840.40)
Wellcare Assist

525%25%25%/YN$363.47
($10,904.22)
Wellcare Assist Open

525%25%25%/YN$363.47
($10,904.22)
Wellcare Giveback

533%33%33%/YN$371.66
($11,149.74)
Wellcare Giveback Open

527%27%27%/YN$371.66
($11,149.74)
Wellcare Low Premium Open

531%31%31%/YN$371.66
($11,149.74)
Wellcare No Premium

533%33%33%/YN$371.66
($11,149.74)
Wellcare No Premium Open

530%30%30%/YN$371.66
($11,149.74)


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SNP Prescription Drug Cost for Piqray

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 Advantra Cares

5NA$0NA/YN$376.11
($11,283.34)
AmeriHealth Caritas VIP Care

2NA25%NA/YN$327.40
($9,821.88)
Cigna TotalCare Plus

5NA$0NA/YN$360.43
($10,812.81)
Highmark Wholecare Medicare Assured Diamond

5NA25%NA/YN$317.15
($9,514.54)
Highmark Wholecare Medicare Assured Ruby

5NA25%NA/YN$317.15
($9,514.54)
HumanaChoice SNP-DE H5216-227

5NA$0NA/YN$357.72
($10,731.71)
Provider Partners Pennsylvania Advantage Plan

1NA25%NA/YN$337.84
($10,135.13)
Provider Partners Pennsylvania Community Plan

1NA25%NA/YN$337.84
($10,135.13)
UnitedHealthcare Dual Complete

5NA$0NA/YN$357.06
($10,711.66)
UnitedHealthcare Dual Complete Select

5NA15%NA/YN$357.06
($10,711.66)
UnitedHealthcare Nursing Home Plan 2

5NA25%NA/YN$357.06
($10,711.66)
UPMC for Life Complete Care

525%25%25%/YN$327.80
($9,834.04)
Wellcare Dual Access

1NA$0NA/YN$363.47
($10,904.22)


Do any Medicare Advantage Plans Cover Piqray? Yes, 53 Medicare Advantage Plans cover this drug in Pennsylvania.

How much does Piqray Cost? $347.15, the average retail cost in Pennsylvania is $347.15 per unit or $10,414.48 for a 30-day supply at in-area pharmacies.

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



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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