Dextroamphetamine saccharate, amphetamine aspartate monohydrate, dextroamphetamine sulfate, amphetamine sulfate Medicare Coverage in Pennsylvania
cover Dextroamphetamine saccharate, amphetamine aspartate monohydrate, dextroamphetamine sulfate, amphetamine sulfate
Medicare Plans Covering Dextroamphetamine saccharate, amphetamine aspartate monohydrate, dextroamphetamine sulfate, amphetamine sulfate 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 |
|---|---|---|---|---|---|---|
| Keystone 65 Basic Rx (HMO) Lowest Copay | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| UPMC for Life Complete Care (HMO D-SNP) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| HumanaChoice Giveback H5525-085 (PPO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Humana Gold Plus H6622-037 (HMO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Jefferson Health Plans Special (HMO D-SNP) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Aetna Community HealthChoices (HMO D-SNP) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| DEVOTED GIVEBACK 015 PA (HMO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| DEVOTED CHOICE 007 PA (PPO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| DEVOTED GIVEBACK 009 PA (HMO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $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 → |
| Wellcare Simple (HMO-POS) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Clover Health Choice (PPO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Humana Gold Plus H6622-054 (HMO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Jefferson Health Plans Complete (HMO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Aetna Community HealthChoices (HMO D-SNP) | $0.00/mo | Tier 4 - Non-Preferred Drug | $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 → |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | $0.00/mo | Tier 1 - Preferred Generic | $0.00 | N/A | None | Details → |
| DEVOTED CHOICE GIVEBACK 008 PA (PPO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Perennial Advantage Freedom (HMO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| DEVOTED CORE 010 PA (HMO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $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 → |
| DEVOTED CORE 023 PA (HMO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Jefferson Health Plans Flex (PPO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Jefferson Health Plans Giveback (HMO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $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 → |
| HumanaChoice H5525-051 (PPO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| DEVOTED CHOICE 010 PA (PPO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Humana Gold Choice H8145-052 (PFFS) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
Compare All Pennsylvania Plans for Dextroamphetamine saccharate, amphetamine aspartate monohydrate, dextroamphetamine sulfate, amphetamine sulfate
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Frequently Asked Questions
100% of Medicare Part D plans in Pennsylvania cover Dextroamphetamine saccharate, amphetamine aspartate monohydrate, dextroamphetamine sulfate, amphetamine sulfate. 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, Keystone 65 Basic Rx (HMO) offers one of the lowest copays for Dextroamphetamine saccharate, amphetamine aspartate monohydrate, dextroamphetamine sulfate, amphetamine sulfate in Pennsylvania. Enter your ZIP code to see all plans and compare total annual costs including premiums.
Dextroamphetamine saccharate, amphetamine aspartate monohydrate, dextroamphetamine sulfate, amphetamine sulfate 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 Dextroamphetamine saccharate, amphetamine aspartate monohydrate, dextroamphetamine sulfate, amphetamine sulfate
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