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butalbital and acetaminophen Medicare Coverage in Pennsylvania

100%
of plans in Pennsylvania
cover butalbital and acetaminophen
28 of 28 plans
28
Plans shown below

Medicare Plans Covering butalbital and acetaminophen 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
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) Lowest Copay $0.00/mo Tier 1 - Preferred Generic $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 →
AmeriHealth Caritas VIP Care (HMO D-SNP) $0.00/mo Tier 2 - Generic $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 →
Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) $13.10/mo Tier 1 - Preferred Generic $0.00 N/A None Details →
Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) $17.60/mo Tier 1 - Preferred Generic $0.00 N/A None Details →
Security Blue HMO-POS Standard (HMO-POS) $51.80/mo Tier 2 - Generic $0.00 N/A None Details →
Security Blue HMO-POS Standard (HMO-POS) $51.80/mo Tier 2 - Generic $0.00 N/A None Details →
Security Blue HMO-POS Deluxe (HMO-POS) $95.90/mo Tier 2 - Generic $0.00 N/A None Details →
Security Blue HMO-POS Deluxe (HMO-POS) $95.90/mo Tier 2 - Generic $0.00 N/A None Details →
Freedom Blue PPO Select (PPO) $95.70/mo Tier 2 - Generic $13.00 N/A None Details →
Freedom Blue PPO Standard (PPO) $98.20/mo Tier 2 - Generic $13.00 N/A None Details →
Freedom Blue PPO Select (PPO) $115.70/mo Tier 2 - Generic $13.00 N/A None Details →
Freedom Blue PPO Deluxe (PPO) $122.40/mo Tier 2 - Generic $13.00 N/A None Details →
Freedom Blue PPO Classic (PPO) $140.90/mo Tier 2 - Generic $13.00 N/A None Details →
Freedom Blue PPO Classic (PPO) $145.40/mo Tier 2 - Generic $13.00 N/A None Details →
Keystone 65 Focus Rx (HMO-POS) $0.00/mo Tier 4 - Non-Preferred Drug 0.4% N/A None Details →
Keystone 65 Focus Rx (HMO-POS) $0.00/mo Tier 4 - Non-Preferred Drug 0.4% N/A None Details →
Personal Choice 65 Achieve Rx (PPO) $0.00/mo Tier 4 - Non-Preferred Drug 0.3% N/A None Details →
Keystone 65 Basic Rx (HMO) $0.00/mo Tier 4 - Non-Preferred Drug 0.4% N/A None Details →
Keystone 65 Essential Rx (HMO-POS) $31.00/mo Tier 4 - Non-Preferred Drug 0.3% N/A None Details →
Keystone 65 Select Rx (HMO) $47.00/mo Tier 4 - Non-Preferred Drug 0.4% N/A None Details →
Keystone 65 Preferred Rx (HMO) $59.70/mo Tier 4 - Non-Preferred Drug 0.4% N/A None Details →
Keystone 65 Select Rx (HMO) $63.50/mo Tier 4 - Non-Preferred Drug 0.4% N/A None Details →
Keystone 65 Preferred Rx (HMO) $79.70/mo Tier 4 - Non-Preferred Drug 0.4% N/A None Details →
Personal Choice 65 Plus Rx (PPO) $81.20/mo Tier 4 - Non-Preferred Drug 0.4% N/A None Details →
Personal Choice 65 Rx (PPO) $102.20/mo Tier 4 - Non-Preferred Drug 0.3% N/A None Details →
Personal Choice 65 Rx (PPO) $112.70/mo Tier 4 - Non-Preferred Drug 0.3% N/A None Details →

Compare All Pennsylvania Plans for butalbital and acetaminophen

Enter your exact ZIP code to see plans available in your specific county, ranked by total annual cost.

Frequently Asked Questions

100% of Medicare Part D plans in Pennsylvania cover butalbital and acetaminophen. There are 28 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, Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) offers one of the lowest copays for butalbital and acetaminophen in Pennsylvania. Enter your ZIP code to see all plans and compare total annual costs including premiums.

butalbital and acetaminophen Coverage in Other States

Click any state to see the plans and costs available there.

Coverage data from CMS formulary files for plan year 2026. How we calculate costsNational coverage for butalbital and acetaminophen

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