Thyroid hormone on every 2026 Pennsylvania Part D plan
Pick a drug class, or type the drugs you want to check, and see which of the 12 stand-alone Part D plans in Pennsylvania cover each one, on what tier, and with what restrictions.
- Covered
- Covered, needs prior authorization (PA) or step therapy (ST)
- Not on the formulary
- QL 60/30d = quantity limit, 60 units per 30 days
12 plans, cheapest premium first. Scroll sideways for all of them →
| Drug | Humana Basic Rx Plan$6.60/moS5884-104 | Wellcare Value Script$8.20/moS4802-141 | Wellcare Classic$14.70/moS4802-080 | Humana Value Rx Plan$19.40/moS5884-185 | SilverScript Choice$22.70/moS5601-012 | AARP Medicare Rx Saver from UHC$43.50/moS5921-351 | HealthSpring Extra Rx$62.60/moS5617-356 | HealthSpring Assurance Rx$74.00/moS5617-215 | AARP Medicare Rx Preferred from UHC$121.90/moS5921-388 | Humana Premier Rx Plan$123.60/moS5884-152 | Blue Rx PDP Complete$164.80/moS5593-003 | Blue Rx PDP Plus$193.20/moS5593-002 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| levothyroxinegeneric Synthroid | Tier 1$0.00 | Tier 1$0.00 | Tier 2$10.00 | Tier 1$0.00 | Tier 1$2.00 | Tier 1$2.00 | Tier 1$0.00 | Tier 2$2.00 | Tier 1$5.00 | Tier 1$0.00 | Tier 1$0.00 | Tier 125% |
| Synthroidlevothyroxine | Tier 325% | Tier 440% | Tier 428% | Tier 320% | Tier 435% | Tier 316% | Tier 431% | Tier 431% | Tier 316% | Tier 3$45.00 | Tier 325% | Tier 325% |
| Levoxyllevothyroxine | Tier 433% | Tier 1$0.00 | Not covered | Tier 433% | Tier 1$2.00 | Tier 316% | Tier 317% | Tier 321% | Tier 316% | Tier 450% | Tier 325% | Tier 325% |
| Unithroidlevothyroxine | Not covered | Tier 1$0.00 | Not covered | Not covered | Tier 1$2.00 | Tier 316% | Tier 317% | Tier 431% | Tier 316% | Not covered | Tier 325% | Tier 325% |
| liothyroninegeneric Cytomel | Tier 325% | Tier 2$3.00 | Tier 325% | Tier 320% | Tier 2$10.00 | Tier 316% | Tier 317% | Tier 321% | Tier 2$10.00 | Tier 3$45.00 | Tier 2$5.00 | Tier 225% |
Where a plan covers several strengths or forms of a drug, the cell shows the least restricted one. Costs are the 30-day preferred-pharmacy cost-sharing in the initial coverage phase, from the CMS 2026 formulary files. Click a plan for its full drug list.