Does PacificSource Medicare Essentials Rx 6 (HMO) cover aripiprazole?
PacificSource Medicare Essentials Rx 6 (HMO)
H3864-006-0 · MA_LOCAL · Medicare Part D
aripiprazole
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.
aripiprazoleunder PacificSource Medicare Essentials Rx 6 (HMO)
Covered — some forms require step therapy
3 of 18 covered forms have a condition attached. You may need to try a cheaper medication first — your doctor’s office handles it.
What you'd pay
28%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. Before that, you pay the full price until you have paid $99 this year.
This plan charges the same at every pharmacy in its network — where you fill it will not change this figure.
Amount limit applies — how much depends on the strength you are prescribed — the cap for each one is listed below. You can still fill it; more than that needs your plan's approval, which your doctor's office requests.
- Tier
- Tier 4
- Approval first
- Not needed
- Try another first
- Required
- Amount limit
- Varies by strength
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)
- 1.5 ML aripiprazole 200 MG/ML Prefilled Syringe [Abilify]Tier 5
- 2 ML aripiprazole 200 MG/ML Prefilled Syringe [Abilify]Tier 5
- 2.4 ML aripiprazole 300 MG/ML Prefilled Syringe [Abilify]Tier 5
- 3.2 ML aripiprazole 300 MG/ML Prefilled Syringe [Abilify]Tier 5
- aripiprazole 1 MG/ML Oral SolutionTier 4
- aripiprazole 10 MG Disintegrating Oral TabletTier 4
- aripiprazole 10 MG Oral Film [Opipza]Tier 5Try another first90 units per 30 days
- aripiprazole 10 MG Oral TabletTier 4
- aripiprazole 15 MG Disintegrating Oral TabletTier 4
- aripiprazole 15 MG Oral TabletTier 430 tablets per 30 days
- aripiprazole 2 MG Oral Film [Opipza]Tier 5Try another first120 units per 30 days
- aripiprazole 2 MG Oral TabletTier 4
- aripiprazole 20 MG Oral TabletTier 4
- aripiprazole 30 MG Oral TabletTier 430 tablets per 30 days
- aripiprazole 300 MG Injection [Abilify]Tier 5
- aripiprazole 400 MG Injection [Abilify]Tier 5
- aripiprazole 5 MG Oral Film [Opipza]Tier 5Try another first90 units per 30 days
- aripiprazole 5 MG Oral TabletTier 4