Butalbital, Acetaminophen, and Caffeine Medicare Coverage in Pennsylvania
cover Butalbital, Acetaminophen, and Caffeine
Medicare Plans Covering Butalbital, Acetaminophen, and Caffeine in Pennsylvania
Sorted by lowest 30-day copay at a preferred pharmacy. Prices shown are estimates from CMS formulary data.
| Plan Name | Monthly Premium | Tier | 30-day Copay | Stars | Restrictions | Action |
|---|---|---|---|---|---|---|
| Erickson Advantage Guardian (HMO-POS I-SNP) Lowest Copay | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| HumanaChoice H5525-051 (PPO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | $0.00/mo | Tier 1 - Preferred Generic | $0.00 | N/A | None | Details → |
| UHC Complete Care PA-17 (HMO-POS C-SNP) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| UHC Dual Complete PA-S3 (HMO-POS D-SNP) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Geisinger Gold Preferred Complete Rx (PPO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Humana USAA Honor Giveback with Rx (PPO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| UPMC for Life Complete Care (HMO D-SNP) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| AARP Medicare Advantage Extras from UHC PA-18 (HMO-POS) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Humana Gold Plus H6622-035 (HMO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| HumanaChoice SNP-DE H5216-227 (PPO D-SNP) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| HumanaChoice Giveback H5525-085 (PPO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| HumanaChoice SNP-DE H7617-048 (PPO D-SNP) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| AARP Medicare Advantage from UHC PA-0010 (PPO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Keystone First VIP Choice (HMO D-SNP) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Humana Gold Plus H6622-036 (HMO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Geisinger Gold Classic 360 Rx (HMO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| HumanaChoice Giveback H5525-085 (PPO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Humana Gold Choice H8145-052 (PFFS) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| AARP Medicare Advantage from UHC PA-0011 (PPO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Geisinger Gold Secure Rx (HMO D-SNP) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Humana Gold Plus H6622-037 (HMO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| UHC Dual Complete PA-S001 (PPO D-SNP) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | $0.00/mo | Tier 1 - Preferred Generic | $0.00 | N/A | None | Details → |
| AARP Medicare Advantage from UHC PA-0002 (HMO-POS) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Geisinger Gold Classic Essential Rx (HMO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| AARP Medicare Advantage Giveback from UHC PA-12 (PPO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
Compare All Pennsylvania Plans for Butalbital, Acetaminophen, and Caffeine
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Frequently Asked Questions
100% of Medicare Part D plans in Pennsylvania cover Butalbital, Acetaminophen, and Caffeine. There are 30 plans available. Coverage and costs vary by specific plan.
Costs vary by plan. Compare plans to find the lowest cost option for you.
Based on current CMS data, Erickson Advantage Guardian (HMO-POS I-SNP) offers one of the lowest copays for Butalbital, Acetaminophen, and Caffeine in Pennsylvania. Enter your ZIP code to see all plans and compare total annual costs including premiums.
Butalbital, Acetaminophen, and Caffeine Coverage in Other States
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Coverage data from CMS formulary files for plan year 2026. How we calculate costs • National coverage for Butalbital, Acetaminophen, and Caffeine
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