• This drug is known as a high-risk medication (HRM) for patients 65 years and older. This drug may cause side effects if taken on a regular basis. We suggest you talk with your doctor to see if an alternative drug is available to treat your condition.

     

    BUT/ASA/CAFF CAP is a Tier 3 generic drug. You pay the following costs at a network pharmacy:

    Peoples Health Choices 65 (HMO-POS) Northshore

    30-Day Supply: $45 at a retail pharmacy

    100-Day Supply:$135 at a retail or mail-order pharmacy


    The costs listed above apply if the drug is covered by Medicare Part D; if the drug is covered by Medicare Part B, the costs may vary. Contact Peoples Health for more information.

    There is a limit on the amount of this drug that you can fill: 180 per 30 days (* depending on package size) .

    The plan will cover only a certain amount of this drug for 1 copay or over a certain number of days. These limits may be in place to ensure safe and effective use of the drug. If your doctor prescribes more than this amount or thinks the limit is not right for your situation, you or your doctor can ask the plan to cover the additional quantity.

    If you receive Extra Help from Medicare to pay for your prescription drug costs, your costs will be different. You will pay one of the following costs, depending on your level of Extra Help.

    Level 1: $4.15     Level 2: $1.45     Level 3: $0     Level 4: 15% coinsurance

    Extra Help is available for people with limited income and resources. Click here for more information about extra help.

    Click here to view other drugs in this therapeutic category.

    This drug is covered in the coverage gap for Peoples Health Group Medicare (HMO-POS), Peoples Health Group Medicare (HMO-POS) for Office of Group Benefits, Peoples Health Secure Health (HMO-POS D-SNP), and Peoples Health Secure Complete (HMO-POS D-SNP) plan members. Please see your plan's Evidence of Coverage for more information.

Last updated 10/02/2023