FillMapSCAN MyChoice WA (HMO)

Does SCAN MyChoice WA (HMO) cover tacrolimus?

SCAN MyChoice WA (HMO)
H4026-002-0 · MA_LOCAL · Medicare Part D
tacrolimus
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.

tacrolimusunder SCAN MyChoice WA (HMO)
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
$42per 30-day fill

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 $250 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