Lidocaine and Prilocaine Medicare Coverage in Pennsylvania
cover Lidocaine and Prilocaine
Medicare Plans Covering Lidocaine and Prilocaine 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 |
|---|---|---|---|---|---|---|
| Complete Blue PPO Signature (PPO) Lowest Copay | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Keystone 65 Basic Rx (HMO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Community Blue Medicare HMO Distinct (HMO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Community Blue Medicare HMO Signature (HMO) | $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 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Humana Gold Plus H6622-037 (HMO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Jefferson Health Plans Special (HMO D-SNP) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Capital Blue Cross Value (PPO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Community Blue Medicare HMO Signature (HMO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Aetna Community HealthChoices (HMO D-SNP) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| DEVOTED GIVEBACK 015 PA (HMO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Complete Blue HMO Distinct (HMO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| DEVOTED CHOICE 007 PA (PPO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| DEVOTED GIVEBACK 009 PA (HMO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Community Blue Medicare HMO Distinct (HMO) | $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 → |
| Complete Blue PPO Signature (PPO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Wellcare Simple (HMO-POS) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Community Blue Medicare HMO Signature (HMO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Clover Health Choice (PPO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Humana Gold Plus H6622-054 (HMO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Jefferson Health Plans Complete (HMO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Capital Blue Cross Value (PPO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Community Blue Medicare HMO Signature (HMO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Aetna Community HealthChoices (HMO D-SNP) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Geisinger Gold Classic 360 Rx (HMO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Complete Blue HMO Distinct (HMO) | $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 → |
| DEVOTED CHOICE GIVEBACK 008 PA (PPO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
Compare All Pennsylvania Plans for Lidocaine and Prilocaine
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 Lidocaine and Prilocaine. There are 30 plans available. Coverage and costs vary by specific plan.
The average 30-day copay for Lidocaine and Prilocaine in Pennsylvania is $0.97 at a preferred pharmacy. Costs vary by plan. Compare plans to find the lowest cost option for you.
Based on current CMS data, Complete Blue PPO Signature (PPO) offers one of the lowest copays for Lidocaine and Prilocaine in Pennsylvania. Enter your ZIP code to see all plans and compare total annual costs including premiums.
Lidocaine and Prilocaine 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 Lidocaine and Prilocaine
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