FillMapKeystone 65 Basic Rx (HMO)

Does Keystone 65 Basic Rx (HMO) cover dasatinib?

Keystone 65 Basic Rx (HMO)
H3952-055-0 · MA_LOCAL · Medicare Part D
dasatinib
Do you get help with your Medicare drug costs?None of these

Optional. Some plans charge less at a preferred pharmacy. Enter your ZIP to see which pharmacies near you take this plan — pick yours and the price above is re-worked for it. Until you do, we show what a standard pharmacy costs. Nothing here is saved.

dasatinibunder Keystone 65 Basic Rx (HMO)
Covered — requires prior authorization
Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
33%of the price your plan negotiates

Medicare hasn’t published this plan’s negotiated price for this drug yet — that file is updated every three months, and newly launched drugs appear in it late. Your pharmacy can quote the exact amount today. Part D caps what you pay out of pocket at $2,100 for 2026. From the first fill — no deductible on this drug.

This plan charges the same at every pharmacy in its network — where you fill it will not change this figure.

Amount limit applies — this plan covers 30 tablets per 30 days. You can still fill it — more than that needs your plan's approval, which your doctor's office requests.
Tier
Tier 5
Approval first
Required
Try another first
No
Amount limit
30 tablets per 30 days
Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 16, 2026 · CMS Part D monthly PUF. Reference information, not medical advice and not a price.

Covered forms and strengths (18)

  • dasatinib 100 MG Oral TabletTier 5Approval first
  • dasatinib 100 MG Oral Tablet [Phyrago]Tier 5Approval first30 tablets per 30 days
  • dasatinib 100 MG Oral Tablet [Sprycel]Tier 5Approval first30 tablets per 30 days
  • dasatinib 140 MG Oral TabletTier 5Approval first
  • dasatinib 140 MG Oral Tablet [Phyrago]Tier 5Approval first30 tablets per 30 days
  • dasatinib 140 MG Oral Tablet [Sprycel]Tier 5Approval first30 tablets per 30 days
  • dasatinib 20 MG Oral TabletTier 5Approval first
  • dasatinib 20 MG Oral Tablet [Phyrago]Tier 5Approval first30 tablets per 30 days
  • dasatinib 20 MG Oral Tablet [Sprycel]Tier 5Approval first30 tablets per 30 days
  • dasatinib 50 MG Oral TabletTier 5Approval first
  • dasatinib 50 MG Oral Tablet [Phyrago]Tier 5Approval first30 tablets per 30 days
  • dasatinib 50 MG Oral Tablet [Sprycel]Tier 5Approval first30 tablets per 30 days
  • dasatinib 70 MG Oral TabletTier 5Approval first
  • dasatinib 70 MG Oral Tablet [Phyrago]Tier 5Approval first30 tablets per 30 days
  • dasatinib 70 MG Oral Tablet [Sprycel]Tier 5Approval first30 tablets per 30 days
  • dasatinib 80 MG Oral TabletTier 5Approval first
  • dasatinib 80 MG Oral Tablet [Phyrago]Tier 5Approval first30 tablets per 30 days
  • dasatinib 80 MG Oral Tablet [Sprycel]Tier 5Approval first30 tablets per 30 days

← All coverage for dasatinib