Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate Medicare Coverage in Pennsylvania
cover Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate
Medicare Plans Covering Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate 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 |
|---|---|---|---|---|---|---|
| Security Blue HMO-POS Standard (HMO-POS) Lowest Copay | $51.80/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Security Blue HMO-POS Standard (HMO-POS) | $51.80/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Security Blue HMO-POS Deluxe (HMO-POS) | $95.90/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Security Blue HMO-POS Deluxe (HMO-POS) | $95.90/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Freedom Blue PPO Select (PPO) | $95.70/mo | Tier 4 - Non-Preferred Drug | $95.00 | N/A | None | Details → |
| Freedom Blue PPO Standard (PPO) | $98.20/mo | Tier 4 - Non-Preferred Drug | $95.00 | N/A | None | Details → |
| Freedom Blue PPO Select (PPO) | $115.70/mo | Tier 4 - Non-Preferred Drug | $95.00 | N/A | None | Details → |
| Freedom Blue PPO Deluxe (PPO) | $122.40/mo | Tier 4 - Non-Preferred Drug | $95.00 | N/A | None | Details → |
| Freedom Blue PPO Classic (PPO) | $140.90/mo | Tier 4 - Non-Preferred Drug | $95.00 | N/A | None | Details → |
| Freedom Blue PPO Classic (PPO) | $145.40/mo | Tier 4 - Non-Preferred Drug | $95.00 | N/A | None | Details → |
Compare All Pennsylvania Plans for Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate
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Frequently Asked Questions
100% of Medicare Part D plans in Pennsylvania cover Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate. There are 10 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, Security Blue HMO-POS Standard (HMO-POS) offers one of the lowest copays for Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate in Pennsylvania. Enter your ZIP code to see all plans and compare total annual costs including premiums.
Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate 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, Caffeine, and Codeine Phosphate
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