MICARDIS TAB 40MG is not a covered drug.

---

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: 30 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: $9.85     Level 2: $4.00     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.

---

You can ask us to make an exception and cover your drug. Click here for information on how to request an exception (which is a type of coverage determination).