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Search 2013 Top Long-Term Care Prescription Drugs
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.
Below, you will find a chart of the most popular long-term care (or LTC) drugs cross-referenced to both the Medicare Part D prescription drug plans (PDPs) qualifying for the Low-Income Subsidy (LIS) $0 monthly premium and the institutional Medicare Advantage Special Needs Plans (SNPs). The coverage overview for each drug by plan is shown within the chart. Plan coverage with no usage management restrictions is shown in dark green, drugs with quantity limits restrictions in light green, step therapy and/or prior authorization restrictions in white and no plan coverage is shown in red.

You can click on the Medicare plan name to access the full plan formulary or click on the drug name to review coverage for this drug across all plans.

Below are Links to other State Summary Charts for the top LTC Drugs on LIS and SNP Medicare Plans:
AK  AL  AR  AZ  CA  CO  CT  DC  DE  FL  GA  HI  IA  ID  IL  IN  KS  KY  LA  MA  MD  ME  MI  MN  MO  MS  MT  NC  ND  NE  NH  NJ  NM  NV  NY  OH  OK  OR  PA  PR  RI  SC  SD  TN  TX  UT  VA  VT  WA  WI  WV  WY 

Long-Term Care (LTC) / LIS Plan Drug List Summary for AZ

           

Key
 C Covered - No restrictions
 Q Has quantity limits
 S Has step therapy
 P Has prior authorization
 N Not Covered
Aetna CVS/pharmacy Prescription Drug Plan (PDP)
S5810-062		EnvisionRxPlus Silver (PDP)
S7694-028		First Health Part D Essentials (PDP)
S5768-162		HealthSpring Prescription Drug Plan-Reg 28 (PDP)
S5932-027		Humana Walmart-Preferred Rx Plan (PDP)
S5884-146		Reader''s Digest Value Rx (PDP)
S0128-029		SilverScript Basic (PDP)
S5601-056		SmartD Rx Saver (PDP)
S0064-028		United American - Select (PDP)
S5755-099		WellCare Classic (PDP)
S5967-165		CareMore Touch (HMO SNP)
H2593-003		CareMore Touch (HMO SNP)
H2593-009		UnitedHealthcare Nursing Home Plan (PPO SNP)
H0319-001
ABILIFY
Q C QP Q Q Q Q N Q QP QP QP C
ABILIFY DISCMELT
Q C QP Q Q Q Q N Q QP Q Q C
ACIPHEX
 N N N N N N N N N N N N N
ACTONEL
 N N Q SQ Q Q N N QPS N Q Q C
ACTOS
Q N N N Q SQP Q N Q N N N C
ACYCLOVIR
C C Q C P P C N C C Q Q C
ACYCLOVIR SODIUM
 P C C C C C P N C C P P P
ADVAIR DISKUS
Q C N Q Q N Q N N Q Q Q C
ADVAIR HFA
Q C N Q Q N Q N N Q Q Q C
AGGRENOX
Q C Q Q C C C N C C C C C
ALBUTEROL SULFATE
 P P P QP P P P N P P P P P
ALENDRONATE SODIUM
Q C C Q Q Q Q N Q Q Q Q C
AMBIEN
 N N N N N N N N N N N N N
AMBIEN CR
 N N N N N N N N N N N N N
AMITIZA
Q C QP Q C C Q S N C C SQ Q C
AMLODIPINE BESYLATE
Q C Q C Q Q Q N Q Q Q Q C
APIDRA
 N C N N N N N N N N N N C
ARANESP ALBUMIN FREE
 P N N P N N P N QP N QP QP P
ARIXTRA
 N N N N N N N N N N N N C
ATACAND
 N N N N N N N N N N N N N
ATACAND HCT
 N N N N N N N N N N N N N
AVAPRO
 N N N N N N N N N N N N N
AVELOX
C N Q C N N C N N N N N C
AVELOX ABC PACK
C N Q C N N C N N N N N C
AVELOX IV
C N C C C C C N N N N N C
 Aetna CVS/pharmacy Prescription Drug Plan (PDP)
S5810-062		EnvisionRxPlus Silver (PDP)
S7694-028		First Health Part D Essentials (PDP)
S5768-162		HealthSpring Prescription Drug Plan-Reg 28 (PDP)
S5932-027		Humana Walmart-Preferred Rx Plan (PDP)
S5884-146		Reader''s Digest Value Rx (PDP)
S0128-029		SilverScript Basic (PDP)
S5601-056		SmartD Rx Saver (PDP)
S0064-028		United American - Select (PDP)
S5755-099		WellCare Classic (PDP)
S5967-165		CareMore Touch (HMO SNP)
H2593-003		CareMore Touch (HMO SNP)
H2593-009		UnitedHealthcare Nursing Home Plan (PPO SNP)
H0319-001
AZATHIOPRINE
 P P C C P P P N P P P P C
BENICAR
Q C Q Q S N N Q N N N N N C
BENICAR HCT
Q C Q Q S N N Q N N N N N C
BETASERON
 N C QP N QP QP QP N QP N QP QP P
BONIVA
QP N QP N N N QP N N QP QP QP P
BROVANA
 N N QP N QP QP N N N N N N P
BYETTA
Q N QP Q Q SQP QP N C C Q Q C
BYSTOLIC
C N Q N N N C N C N C C C
CARVEDILOL
C C C C C C C N C C Q Q C
CEFTAZIDIME
C N C C C C C N C C P P C
CEFTRIAXONE
C C C C C C C N C C P P C
CELEBREX
C C Q Q S N N QP N Q N Q Q C
CELLCEPT
 P P P P P P P N P P P P P
CHANTIX
Q SQ QP QP Q Q QP N QP Q QP QP C
COLCRYS
Q C Q C Q Q Q N Q C Q Q C
COPAXONE
QP C QP QP QP QP QP N QP QP QP QP P
COZAAR
 N N N N N N N N N N N N N
CUBICIN
 N N P P P P P N P P N N P
DEXTROSE
 P C C C C C C N C C P P C
DONEPEZIL HYDROCHLORIDE
Q C Q Q Q Q Q N Q C Q Q C
ELESTAT
C N N N C C N N N N N N N
ELIDEL
Q SC Q SC C C P N C N QP QP C S
ENABLEX
 N C SQ S N N N N N N N N N N
ENOXAPARIN SODIUM INJECTION
C C P Q Q Q Q N C Q Q Q C
EPOGEN
 N N N N QP QP N N QP P N N P
 Aetna CVS/pharmacy Prescription Drug Plan (PDP)
S5810-062		EnvisionRxPlus Silver (PDP)
S7694-028		First Health Part D Essentials (PDP)
S5768-162		HealthSpring Prescription Drug Plan-Reg 28 (PDP)
S5932-027		Humana Walmart-Preferred Rx Plan (PDP)
S5884-146		Reader''s Digest Value Rx (PDP)
S0128-029		SilverScript Basic (PDP)
S5601-056		SmartD Rx Saver (PDP)
S0064-028		United American - Select (PDP)
S5755-099		WellCare Classic (PDP)
S5967-165		CareMore Touch (HMO SNP)
H2593-003		CareMore Touch (HMO SNP)
H2593-009		UnitedHealthcare Nursing Home Plan (PPO SNP)
H0319-001
ESCITALOPRAM [LEXAPRO]
Q C Q Q Q Q Q N Q Q Q Q C
EXELON
C N Q Q Q Q Q N C C N N C
EXELON PATCH
C Q Q Q Q Q Q N Q Q C C C S
FENTANYL PATCH
Q Q SQ Q Q Q QP N Q Q Q Q C
FEXOFENADINE HCL
 N N N N N N N N N N N N N
FLECTOR PATCH
 N N Q N N N N N C N N N N
FORTAZ
 N N N N N N N N C N N N C
FORTEO
Q SC QP QP Q SQ SQP N Q QP P P P
FOSRENOL
C C Q Q S N N C N C C N N C
FRAGMIN
 N C N N Q Q N N C N QP QP C
GEODON
QPSC QP Q C C Q N C Q QP QP C
HUMALOG
 N N N C Q Q N N Q Q Q Q C
HUMALOG KWIKPEN INJECTION
 N N N C C C N N Q Q Q Q C
HUMALOG MIX 50/50
C N N C C C N N Q Q Q Q C
HUMALOG MIX 75/25
 N N N C C C N N Q Q Q Q C
HUMALOG MIX KWIKPEN INJECTION
C N N C C C N N Q Q Q Q C
IBANDRONATE SODIUM
QP N Q N Q Q QP N C Q N N C
INSPRA
 N N N N N N N N N N N N N
INVEGA
Q C QP Q SQ SQ SQ N Q QP Q Q C
IPRATROPIUM/ALBUTEROL
 N N N N N N N N N N N N N
IPRATROPIUM BROMIDE
QP P P QP QP QP P N P P Q Q P
IPRATROPIUM BROMIDE NASAL
 N N N N N N N N N N N N N
IRBESARTAN [AVAPRO]
Q N Q C Q Q N N Q N Q Q C
LANSOPRAZOLE TABLETS DR
 N N N N N N N N N N N N N
LEUPROLIDE PREFILLED SYRINGE [LUPRON]
 N N N N N N N N N N N N N
 Aetna CVS/pharmacy Prescription Drug Plan (PDP)
S5810-062		EnvisionRxPlus Silver (PDP)
S7694-028		First Health Part D Essentials (PDP)
S5768-162		HealthSpring Prescription Drug Plan-Reg 28 (PDP)
S5932-027		Humana Walmart-Preferred Rx Plan (PDP)
S5884-146		Reader''s Digest Value Rx (PDP)
S0128-029		SilverScript Basic (PDP)
S5601-056		SmartD Rx Saver (PDP)
S0064-028		United American - Select (PDP)
S5755-099		WellCare Classic (PDP)
S5967-165		CareMore Touch (HMO SNP)
H2593-003		CareMore Touch (HMO SNP)
H2593-009		UnitedHealthcare Nursing Home Plan (PPO SNP)
H0319-001
LEVEMIR
C C C C C C C N Q Q Q Q C
LEXAPRO
Q S N N N N N N N N N N N N
LIDOCAINE DCL 1% VIAL
 P C C C C C C N C C P P P
LIDODERM PATCH
QPSQ Q QP QP QP Q N P Q Q Q C
LOTEMAX
C N C N N N C N C C N N C
LOVAZA
Q C Q SQ Q Q C N C C C C C
LOVENOX
 N N N Q N N N N C N Q Q C
LUMIGAN
C C Q Q Q Q Q N C Q Q Q C
LUNESTA
 N N Q N N N Q N N N N N C
LUPRON DEPOT
 P C P QP QP QP QP N C QP N N C
MEGACE ES
 N N Q N N N Q N Q N N N C
MEGACE ORAL
 N N N N N N N N N N N N N
MELOXICAM
C C C C Q Q C N C C Q Q C
MIACALCIN
 N N N C N N N N N P N N P
MORPHINE SULFATE
Q C Q Q Q C Q N C Q Q Q C
NAMENDA
C C Q Q Q Q Q N Q Q Q Q C
NASONEX
C N Q Q Q Q Q N N C N N C
NEUPOGEN
 P C P P QP QP P N QP P P P P
NEXIUM
C N Q Q N N N N N C N N C
NEXIUM IV
C N C C N N C N C N P P C
NITRO-BID
C N C N N N C N C C C C C
NOVOLOG
C C C N C C C N N N Q Q C
NOVOLOG FLEXPEN
C C C N C C C N N N Q Q C
NOVOLOG MIX 70/30
C C C N C C C N N N Q Q C
NUVIGIL
 N N QP N N N N N N N N N N
 Aetna CVS/pharmacy Prescription Drug Plan (PDP)
S5810-062		EnvisionRxPlus Silver (PDP)
S7694-028		First Health Part D Essentials (PDP)
S5768-162		HealthSpring Prescription Drug Plan-Reg 28 (PDP)
S5932-027		Humana Walmart-Preferred Rx Plan (PDP)
S5884-146		Reader''s Digest Value Rx (PDP)
S0128-029		SilverScript Basic (PDP)
S5601-056		SmartD Rx Saver (PDP)
S0064-028		United American - Select (PDP)
S5755-099		WellCare Classic (PDP)
S5967-165		CareMore Touch (HMO SNP)
H2593-003		CareMore Touch (HMO SNP)
H2593-009		UnitedHealthcare Nursing Home Plan (PPO SNP)
H0319-001
OMEPRAZOLE
C C Q Q Q Q Q N Q C Q Q C
ONDANSETRON
QP QP C Q QP QP P N QP C QP QP P
ONDANSETRON HCL
QP QP P Q QP QP P N QP P QP QP P
ONDANSETRON ODT
QP QP N Q QP QP P N QP C QP QP P
ONGLYZA
 N C Q N Q SQ S N N Q Q N N C
OXYCONTIN
 N C N QP N N Q N Q N N N N
PALIPERIDONE (24 HR) ER [INVEGA]
 N N N N N N N N N N N N N
PANTOPRAZOLE SODIUM
C C Q Q Q Q N N Q C Q Q C
PATADAY
C C Q C C C C N C C N N C
PLAVIX
Q N N N N N N N N N N N N
PRADAXA
Q C Q N Q Q C N C Q Q Q P
PREVACID DELAYED RELEASE
 N N N N N N N N N N N N N
PREVACID SOLUTAB
 N N N N N N N N N N N N N
PRILOSEC
 N N N N N N N N N N N N N
PROCRIT
QP QP QP P QP QP P N QP P QP QP P
PROGRAF
 P P N P P P P N C P P P P
PROLIA INJECTION
QP N QP Q SQP QP Q N N QP C C P
PROMETHAZINE
 N N C C N N C N C P N N C
PROMETHAZINE HCL
 P N C P N N P N C P N N C
PROMETHAZINE VC
 N N N C N N N N N C N N C
PROTONIX
 N N N N C C N N N N N N C
PROVIGIL
QP N N N N N QP N QP N N N P
PULMICORT
 N N N N N N QP N P N N N P
PULMICORT FLEXHALER
 N C N N N N N N N C N N C
RANEXA
Q SC Q SQ S N Q SQP N C Q Q Q C S
 Aetna CVS/pharmacy Prescription Drug Plan (PDP)
S5810-062		EnvisionRxPlus Silver (PDP)
S7694-028		First Health Part D Essentials (PDP)
S5768-162		HealthSpring Prescription Drug Plan-Reg 28 (PDP)
S5932-027		Humana Walmart-Preferred Rx Plan (PDP)
S5884-146		Reader''s Digest Value Rx (PDP)
S0128-029		SilverScript Basic (PDP)
S5601-056		SmartD Rx Saver (PDP)
S0064-028		United American - Select (PDP)
S5755-099		WellCare Classic (PDP)
S5967-165		CareMore Touch (HMO SNP)
H2593-003		CareMore Touch (HMO SNP)
H2593-009		UnitedHealthcare Nursing Home Plan (PPO SNP)
H0319-001
RECLAST INJECTION
 N C N P QP QP N N C N N N P
REGRANEX
QP N QP P C C P N P P QP QP P
REQUIP
 N N N N N N N N N N N N N
REVATIO
QP P N N QP QP QP N QP N N N P
RHINOCORT AQUA
 N N Q N N N N N N N N N N
RISPERDAL CONSTA
Q C Q C Q Q Q N Q Q P P C
RISPERIDONE
Q C Q Q Q Q Q N Q Q Q Q C
ROZEREM
 N N N Q N N N N N N Q Q C
SANCTURA
 N N N N N N N N N N N N N
SANCTURA XR
 N N N N N N N N N N N N C
SIMVASTATIN
Q C P Q Q Q Q N Q C Q Q C
SKELAXIN
 N N N N N N N N N N N N N
STALEVO
C C C N N N C N C N N N C
TAMIFLU
Q C Q Q Q Q Q N Q C Q Q C
TAMSULOSIN HCL
Q C Q C Q Q Q N Q C Q Q C
TAZICEF
 N N N N N N N N N N N N N
TOBRAMYCIN-DEXAMETH OPTH
C C C C C C C N C C C C C
TRANSDERM SCOP
 N N N Q N N N N N N N N C
TRAVATAN Z
C C Q Q Q Q Q N C C Q Q C
TRICOR
C N N C Q Q Q N N N N N C
TRILIPIX
C N Q C N N Q N N N N N C
ULORIC
C C S N C S N N C S N C C SQ Q C S
ULTRAM ER
 N N N N N N N N N N N N N
VANCOMYCIN HCL
 P P QP Q P P P N P P P P P
VOLTAREN
Q N Q Q SC C C N C C C C C
 Aetna CVS/pharmacy Prescription Drug Plan (PDP)
S5810-062		EnvisionRxPlus Silver (PDP)
S7694-028		First Health Part D Essentials (PDP)
S5768-162		HealthSpring Prescription Drug Plan-Reg 28 (PDP)
S5932-027		Humana Walmart-Preferred Rx Plan (PDP)
S5884-146		Reader''s Digest Value Rx (PDP)
S0128-029		SilverScript Basic (PDP)
S5601-056		SmartD Rx Saver (PDP)
S0064-028		United American - Select (PDP)
S5755-099		WellCare Classic (PDP)
S5967-165		CareMore Touch (HMO SNP)
H2593-003		CareMore Touch (HMO SNP)
H2593-009		UnitedHealthcare Nursing Home Plan (PPO SNP)
H0319-001
VOLTAREN EYE DROPS
 N N N N N N N N N N N N N
VOLTAREN-XR
 N N N N N N N N N N N N N
VYTORIN
Q N N N N N N N N Q Q Q C
XARELTO
Q C Q QP Q Q N N C Q C C P
XIFAXAN
 N C N QP QP QP P N Q N QP QP C
XOPENEX
 N N N N N N N N N N N N N
XOPENEX HFA
 N N Q N N N Q N N N N N N
ZEGERID
 N N N N N N N N N N N N N
ZETIA
Q C Q Q Q Q C N Q Q Q Q C
ZIPRASIDONE HCL
QP C Q Q Q Q Q N Q QP Q Q C
ZOSYN
 N N N C N N N N C N P P C
ZYPREXA
C N N N Q Q N N N N QP QP C
ZYPREXA ZYDIS
 N N N N N N N N N N N N N
ZYVOX
QP C QP P C C C N Q QP QP QP P
           





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