FillMapSCAN Connections (HMO D-SNP)

Does SCAN Connections (HMO D-SNP) cover tacrolimus?

SCAN Connections (HMO D-SNP)
H0976-001-0 · MA_LOCAL · Medicare Part D
tacrolimus
Your Extra Help level

Everyone on this plan has Medicare and Medicaid, which qualifies you for Extra Help automatically — so the figures below already use the statutory copays, not this plan’s published cost sharing. Nothing here is saved.

Full Extra Help: no deductible, and at most $5.10 generic or $12.65 brand-name per fill.

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.

tacrolimusunder SCAN Connections (HMO D-SNP)
Covered — some forms require prior authorization
17 of 19 covered forms have a condition attached. Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
25%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 $375 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 — this plan covers 100 grams per 30 days. You can still fill it — more than that needs your plan's approval, which your doctor's office requests.
Tier
Tier 3
Approval first
Required
Try another first
No
Amount limit
100 grams 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 (19)

  • 24 HR tacrolimus 0.5 MG Extended Release Oral CapsuleTier 4Approval first
  • 24 HR tacrolimus 0.5 MG Extended Release Oral Capsule [Astagraf]Tier 4Approval first
  • 24 HR tacrolimus 0.75 MG Extended Release Oral Tablet [Envarsus]Tier 4Approval first
  • 24 HR tacrolimus 1 MG Extended Release Oral CapsuleTier 4Approval first
  • 24 HR tacrolimus 1 MG Extended Release Oral Capsule [Astagraf]Tier 4Approval first
  • 24 HR tacrolimus 1 MG Extended Release Oral Tablet [Envarsus]Tier 4Approval first
  • 24 HR tacrolimus 4 MG Extended Release Oral Tablet [Envarsus]Tier 4Approval first
  • 24 HR tacrolimus 5 MG Extended Release Oral CapsuleTier 4Approval first
  • 24 HR tacrolimus 5 MG Extended Release Oral Capsule [Astagraf]Tier 4Approval first
  • tacrolimus 0.0003 MG/MG Topical OintmentTier 4100 grams per 30 days
  • tacrolimus 0.001 MG/MG Topical OintmentTier 4100 grams per 30 days
  • tacrolimus 0.2 MG Granules for Oral Suspension [Prograf]Tier 4Approval first
  • tacrolimus 0.5 MG Oral CapsuleTier 3Approval first
  • tacrolimus 0.5 MG Oral Capsule [Prograf]Tier 4Approval first
  • tacrolimus 1 MG Granules for Oral Suspension [Prograf]Tier 4Approval first
  • tacrolimus 1 MG Oral CapsuleTier 3Approval first
  • tacrolimus 1 MG Oral Capsule [Prograf]Tier 4Approval first
  • tacrolimus 5 MG Oral CapsuleTier 4Approval first
  • tacrolimus 5 MG Oral Capsule [Prograf]Tier 4Approval first

← All coverage for tacrolimus