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Search 2015 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 CA

           

Key
 C Covered - No restrictions
 Q Has quantity limits
 S Has step therapy
 P Has prior authorization
 N Not Covered
AARP MedicareRx Saver Plus (PDP)
S5921-376		Aetna Medicare Rx Saver (PDP)
S5810-066		Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)
H6229-006		Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
H0148-001		Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
H0148-002		CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan)
H7885-001		CareMore Cal MediConnect Medicare-Medicaid Plan (Medicare-Medicaid Plan)
H6229-005		CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan)
H5172-002		EnvisionRxPlus Silver (PDP)
S7694-032		Health Net Cal MediConnect (Medicare-Medicaid Plan)
H3237-001		Health Net Cal MediConnect (Medicare-Medicaid Plan)
H3237-002		Humana Preferred Rx Plan (PDP)
S5884-114		IEHP DualChoice (Medicare-Medicaid Plan)
H5355-001		L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)
H8258-001		Molina Dual Options (Medicare-Medicaid Plan)
H8677-001		Molina Dual Options (Medicare-Medicaid Plan)
H8677-002		Santa Clara Family Health Plan (Medicare-Medicaid Plan)
H7890-001		SilverScript Choice (PDP)
S5601-064		Symphonix Rite Aid Value Rx (PDP)
S0522-034		CareMore Touch (HMO SNP)
H0544-005		CareMore Touch (HMO SNP)
H0544-005		SCAN Healthy at Home (HMO SNP)
H9104-006		SCAN Healthy at Home (HMO SNP)
H9104-006
ABILIFY
Q Q Q Q Q Q Q Q C SC C Q QP Q Q Q Q Q Q Q Q C SC S
ABILIFY DISCMELT
 N N N N N N N N N N N N N N N N N N N N N N N
ACIPHEX
 N N N N N N N N N N N N N N N N N N N N N N N
ACTONEL
 N N N Q Q C N N N N N N Q C S N N N N N N N C SC S
ACTOS
 N N N N N N N N N N N N N N N N N N N N N N N
ACYCLOVIR
 P P QP QP QP C QP QP C C C P C P P P QP P P QP QP C C
ACYCLOVIR SODIUM
 N N N N N N N N N N N N N N N N N N N N N N N
ADVAIR DISKUS
Q Q Q Q SQ SC Q Q Q C C N Q SQ Q Q Q Q Q Q Q C C
ADVAIR HFA
C Q Q Q SQ S N Q Q Q Q Q N Q SQ Q Q Q Q Q Q Q C C
AGGRENOX
C Q Q C C C Q Q C C C N Q C C C Q C Q Q Q Q Q
ALBUTEROL SULFATE
 P P QP P P P QP P P P P P QP P P P P P P QP QP P P
ALENDRONATE SODIUM
C Q Q Q Q C Q Q Q Q Q Q Q C Q Q Q Q C Q Q C C
AMBIEN
 N N N N N N N N N N 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 N N N N N N N N N N
AMITIZA
Q Q N P P C N Q C N N N C N Q Q Q Q Q N N C C
AMLODIPINE BESYLATE
C C Q Q Q C Q C Q C C Q Q C Q Q C Q Q Q Q C C
APIDRA
 N N N N N N N N C N N N Q N N N N N N N N N N
ARANESP ALBUMIN FREE
 P QP QP P P P QP N N P P N N PS N N N N QP QP QP N N
ARIPIPRAZOLE [Abilify]
Q Q N C C Q N Q C SC C Q QP Q Q Q Q N Q N N C SC S
ARIXTRA
 N N N N N N N N N N N N N N N N N N N N N N N
ATACAND
 N N N N N N N N N N 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 N N N N N N N N N N
AVAPRO
 N N N N N N N N N N N N N N N N N N N N N N N
AVELOX
C N N N N Q N N N N N N N N N N N N N N N N N
AVELOX ABC PACK
C N N N N Q N N N N N N N N N N N N N N N N N
AVELOX IV
C N N N N Q N N N N N N N P N N N N N N N N N
 AARP MedicareRx Saver Plus (PDP)
S5921-376		Aetna Medicare Rx Saver (PDP)
S5810-066		Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)
H6229-006		Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
H0148-001		Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
H0148-002		CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan)
H7885-001		CareMore Cal MediConnect Medicare-Medicaid Plan (Medicare-Medicaid Plan)
H6229-005		CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan)
H5172-002		EnvisionRxPlus Silver (PDP)
S7694-032		Health Net Cal MediConnect (Medicare-Medicaid Plan)
H3237-001		Health Net Cal MediConnect (Medicare-Medicaid Plan)
H3237-002		Humana Preferred Rx Plan (PDP)
S5884-114		IEHP DualChoice (Medicare-Medicaid Plan)
H5355-001		L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)
H8258-001		Molina Dual Options (Medicare-Medicaid Plan)
H8677-001		Molina Dual Options (Medicare-Medicaid Plan)
H8677-002		Santa Clara Family Health Plan (Medicare-Medicaid Plan)
H7890-001		SilverScript Choice (PDP)
S5601-064		Symphonix Rite Aid Value Rx (PDP)
S0522-034		CareMore Touch (HMO SNP)
H0544-005		CareMore Touch (HMO SNP)
H0544-005		SCAN Healthy at Home (HMO SNP)
H9104-006		SCAN Healthy at Home (HMO SNP)
H9104-006
AZATHIOPRINE
C P P P P P P P P P P P P P P P P P C P P P P
BENICAR
Q N N N N N N C SC N N Q N N Q Q C SQ Q N N C SC S
BENICAR HCT
Q N N N N N N C SC N N Q N N Q Q C SQ Q N N C SC S
BETASERON
 N N P C C Q P C SC P P N P N QP QP C SQP P P P C C
Bimatoprost [Lumigan]
 N N N N N C N C C C C N N Q N N C N C N N N N
BONIVA
 N N P N N P P N N N N N N N N N N N N P P N N
BROVANA
 P N N N N N N N N N N N N N N N N N N N N N N
BYETTA
Q N Q P P P Q Q C C SC S N Q S N N N Q N Q SQ Q P P
BYSTOLIC
C N N N N N N C C S N N N N C C C C C N N N N N
CARVEDILOL
C C C C C C C C C C C C C C C C C C Q C C C C
CANDESARTAN CILEXETIL [ATACAND]
 N Q Q N N N Q C N C C Q N C N N C N Q Q Q N N
CARBIDOPA-LEVODOPA-ENTACAPONE [STALEVO]
 N C N C SC SC N C C N N N N C C C C C N N N C C
CEFTAZIDIME
C C P P P C P C N C C C C P C C C C C P P C C
CEFTRIAXONE
C C P P P C P C C C C C C P C C C C C P P C C
CELEBREX
 N N N N N Q S N N C C C N N Q N N N N N N N N N
CELECOXIB [Celebrex]
 N Q N P P Q S N Q C C C N Q Q Q Q Q Q N N N C SC S
CELLCEPT
 P P P N N P P P P P P P P P N N P N P P P N N
CHANTIX
C Q QP P P P QP Q QP P P Q QP C P P Q P QP QP QP C SC S
COLCRYS
C C C C C C C C C C C Q Q C Q Q C Q Q C C Q Q
COPAXONE
 P QP QP P P P QP C C P P QP Q Q QP QP C QP QP QP QP P P
COZAAR
 N N N N N N N N N N N N N N N N N N N N N N N
CUBICIN
C C P P P P P C P C C C P P C C C C C P P C C
DEXTROSE
C P P P P P P P C P P C P P C C P C C P P C C
DONEPEZIL HYDROCHLORIDE
C Q Q C C C Q Q C C C Q Q Q SQ Q Q Q C Q Q C C
ELESTAT
 N N N N N N N N N N N N N N N N N N N N N N N
ELIDEL
C SQ SQP QP QP Q SQP P C SC C C P C P P P P C SQP QP Q Q
ENABLEX
 N N N N N Q S N N P N N N N N N N N N N N N N N
ENOXAPARIN SODIUM INJECTION
Q C Q P P Q Q Q Q C C Q Q Q C C Q C Q Q Q C C
EPOGEN
 P N N P P P N QP N P P QP P N N N QP N N N N N N
 AARP MedicareRx Saver Plus (PDP)
S5921-376		Aetna Medicare Rx Saver (PDP)
S5810-066		Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)
H6229-006		Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
H0148-001		Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
H0148-002		CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan)
H7885-001		CareMore Cal MediConnect Medicare-Medicaid Plan (Medicare-Medicaid Plan)
H6229-005		CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan)
H5172-002		EnvisionRxPlus Silver (PDP)
S7694-032		Health Net Cal MediConnect (Medicare-Medicaid Plan)
H3237-001		Health Net Cal MediConnect (Medicare-Medicaid Plan)
H3237-002		Humana Preferred Rx Plan (PDP)
S5884-114		IEHP DualChoice (Medicare-Medicaid Plan)
H5355-001		L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)
H8258-001		Molina Dual Options (Medicare-Medicaid Plan)
H8677-001		Molina Dual Options (Medicare-Medicaid Plan)
H8677-002		Santa Clara Family Health Plan (Medicare-Medicaid Plan)
H7890-001		SilverScript Choice (PDP)
S5601-064		Symphonix Rite Aid Value Rx (PDP)
S0522-034		CareMore Touch (HMO SNP)
H0544-005		CareMore Touch (HMO SNP)
H0544-005		SCAN Healthy at Home (HMO SNP)
H9104-006		SCAN Healthy at Home (HMO SNP)
H9104-006
ESCITALOPRAM [LEXAPRO]
C Q Q C C C Q C C C C Q Q C Q Q C Q Q Q Q C C
ESOMEPRAZOLE [NEXIUM]
C C N N N N N C N C SC S N C P C C C C Q N N Q SQ S
ESZOPICLONE [LUNESTA]
 N N N N N N N N N N N N N Q N N N N N N N N N
EXELON
 N N N N N N N N N N N N N N N N N N N N N N N
EXELON PATCH
Q SQ Q C C Q Q Q Q C C Q N C Q Q Q Q C Q Q Q Q
FENOFIBRIC ACID [TRILIPIX]
 N C N N N C N C N C C Q N N C C C C N N N Q Q
FENTANYL PATCH
Q Q Q Q SQ SQ Q QP Q SQ Q Q Q C QP QP QP Q Q Q Q Q Q
FEXOFENADINE HCL
 N N N N N N N N N N N N N N N N N N N N N N N
FLECTOR PATCH
 N N N N N N N P N P P N N N N N P N N N N N N
FORTAZ
C N N P P N N N N N N N N N N N N N N N N N N
FORTEO
 P QP QP QP QP P QP QP P Q Q Q S P P QP QP QP QP P QP QP P P
FOSRENOL
C C N N N C N N C C C N C C C C N C N N N C C
FRAGMIN
C N C P P Q C N C C C Q P P N N N N N C C N N
GEODON
C C P P P P P Q C SC C C P P Q Q Q Q C P P C C
HUMALOG
 N N Q C C C Q Q N Q Q C Q C S N N Q N C Q Q C C
Humalog PEN
 N N N N N N N N N N N N N N N N N N N N N N N
HUMALOG KWIKPEN INJECTION
 N N Q C C C Q Q N Q Q C N C S N N Q N C Q Q C C
HUMALOG MIX 50/50
 N N Q C C C Q Q N Q Q C Q N N N Q N C Q Q C C
HUMALOG MIX 75/25
 N N Q C C C Q Q N Q Q C Q N N N Q N C Q Q C C
HUMALOG MIX KWIKPEN INJECTION
 N N Q C C C Q Q N Q Q C N N N N Q N C Q Q C C
IBANDRONATE SODIUM
 N N QP Q Q P QP QP N Q Q N P Q SQP QP QP QP N QP QP PS PS
INSPRA
 N N N N N N N N N N N N N N N N N N N N N N N
INVEGA
Q Q SQ QP QP QP Q Q SC SC C Q SQP P Q Q Q SQ C Q Q C SC S
IPRATROPIUM/ALBUTEROL
 N N N N N N N N N N N N N N N N N N N N N N N
IPRATROPIUM BROMIDE
 P P QP P P P QP Q QP P P QP QP P P P Q P QP QP QP QP QP
IPRATROPIUM BROMIDE NASAL
 N N N N N N N N N N N N N N N N N N N N N N N
IRBESARTAN [AVAPRO]
Q Q Q N N C Q C Q C C Q N C N N C N Q Q Q C C
LANSOPRAZOLE TABLETS DR
 N N N N N N N N N N 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 N N N N N N N N N N
 AARP MedicareRx Saver Plus (PDP)
S5921-376		Aetna Medicare Rx Saver (PDP)
S5810-066		Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)
H6229-006		Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
H0148-001		Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
H0148-002		CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan)
H7885-001		CareMore Cal MediConnect Medicare-Medicaid Plan (Medicare-Medicaid Plan)
H6229-005		CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan)
H5172-002		EnvisionRxPlus Silver (PDP)
S7694-032		Health Net Cal MediConnect (Medicare-Medicaid Plan)
H3237-001		Health Net Cal MediConnect (Medicare-Medicaid Plan)
H3237-002		Humana Preferred Rx Plan (PDP)
S5884-114		IEHP DualChoice (Medicare-Medicaid Plan)
H5355-001		L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)
H8258-001		Molina Dual Options (Medicare-Medicaid Plan)
H8677-001		Molina Dual Options (Medicare-Medicaid Plan)
H8677-002		Santa Clara Family Health Plan (Medicare-Medicaid Plan)
H7890-001		SilverScript Choice (PDP)
S5601-064		Symphonix Rite Aid Value Rx (PDP)
S0522-034		CareMore Touch (HMO SNP)
H0544-005		CareMore Touch (HMO SNP)
H0544-005		SCAN Healthy at Home (HMO SNP)
H9104-006		SCAN Healthy at Home (HMO SNP)
H9104-006
LEVEMIR
C C Q N N N Q N C Q Q C Q C C C N C C Q Q C C
LEXAPRO
 N N N N N N N N N N N N N N N N N N N N N N N
LIDOCAINE DCL 1% VIAL
 N N N N N N N N N N N N N N N N N N N N N N N
LIDODERM PATCH
QP N N N N N N N Q N N N N N N N N QP N N N N N
LINEZOLID [Zyvox]
QP QP N P P Q N C P C C C QP P C C C C P N N C C
LOTEMAX
C N N C C C N C N C C C N C C C C C C N N N N
LOVAZA
 N Q N N N C N N C C C N N C N N N N Q N N N N
LOVENOX
 N N N N N N N N N N N N N N N N N N N N N N N
LUMIGAN
C C C N N Q C Q C C C Q N Q C C Q C C C C Q SQ S
LUNESTA
 N N Q N N N Q N N N N N N N N N N N N Q Q N N
LUPRON DEPOT
 P P P P P C P Q QP C C QP P P P P Q P Q P P C C
MEGACE ES
C N N N N N N C P P P N N N P P C P P N N N N
MEGACE ORAL
 N N N N N N N N P N N N N N N N N N N N N N N
MELOXICAM
C C Q C C C Q C C C C Q C C C C C C Q Q Q C C
MIACALCIN
 P C P P P P P P C C C N C P P P P P C P P P P
MORPHINE
C P C N N N C C N N N Q N P P P C P C C C N N
MORPHINE SULFATE
Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q C C
MOXIFLOXACIN HCL [AVELOX]
C N N C C Q N C N N N N N C N N C N C N N C C
NAMENDA
 P QP Q C C C Q Q Q P P QP Q Q P P Q P QP Q Q C C
NASONEX
C N N N N N N Q N N N N N Q Q Q Q Q Q N N Q Q
NEUPOGEN
 P P P P P P P C QP P P QP P P P P C P P P P P P
NEXIUM
C N N N N N N N C C SC SQ N N Q Q N C Q N N Q SQ S
NEXIUM IV
 N N N N N N N N N N N N N N N N N N C N N N N
NITRO-BID
C N C N N C C C N N N N N N C C C C C C C C C
NOVOLOG
C C Q C C C Q Q C N N C Q C C C Q C N Q Q N N
NOVOLOG FLEXPEN
C C Q C C C Q Q C N N C N C C C Q C N Q Q N N
NOVOLOG MIX 70/30
C C Q C C C Q Q C N N C Q C C C Q C N Q Q N N
NUVIGIL
 N N N N N N N P P N N QP N QP QP QP P QP N N N N N
 AARP MedicareRx Saver Plus (PDP)
S5921-376		Aetna Medicare Rx Saver (PDP)
S5810-066		Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)
H6229-006		Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
H0148-001		Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
H0148-002		CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan)
H7885-001		CareMore Cal MediConnect Medicare-Medicaid Plan (Medicare-Medicaid Plan)
H6229-005		CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan)
H5172-002		EnvisionRxPlus Silver (PDP)
S7694-032		Health Net Cal MediConnect (Medicare-Medicaid Plan)
H3237-001		Health Net Cal MediConnect (Medicare-Medicaid Plan)
H3237-002		Humana Preferred Rx Plan (PDP)
S5884-114		IEHP DualChoice (Medicare-Medicaid Plan)
H5355-001		L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)
H8258-001		Molina Dual Options (Medicare-Medicaid Plan)
H8677-001		Molina Dual Options (Medicare-Medicaid Plan)
H8677-002		Santa Clara Family Health Plan (Medicare-Medicaid Plan)
H7890-001		SilverScript Choice (PDP)
S5601-064		Symphonix Rite Aid Value Rx (PDP)
S0522-034		CareMore Touch (HMO SNP)
H0544-005		CareMore Touch (HMO SNP)
H0544-005		SCAN Healthy at Home (HMO SNP)
H9104-006		SCAN Healthy at Home (HMO SNP)
H9104-006
OMEGA-3 ETHYL ESTERS [Lovaza]
C Q C C C C C C C C C Q Q C C C C C Q C C C C
OMEPRAZOLE
C Q C Q Q C C C C C C Q Q C Q Q C C Q C C C C
ONDANSETRON
 P P QP P P QP QP P QP P P QP P P P P P P P QP QP P P
ONDANSETRON HCL
 P QP QP P P QP QP P QP P P QP P P P P P P P QP QP P P
ONDANSETRON ODT
 P P QP P P QP QP P QP P P QP P P P P P P P QP QP P P
ONGLYZA
 N N N N N C S N N Q C C Q N Q N N N N Q N N C C
OXYCONTIN
 N N N QP QP Q N Q Q N N N N Q N N Q Q N N N Q Q
PALIPERIDONE (24 HR) ER [INVEGA]
 N N N N N N N N N N N N N N N N N N N N N N N
PANTOPRAZOLE SODIUM
C Q C C C C C C C C C Q Q C Q Q C N Q C C C C
PATADAY
C C C N N C C C SC C C C C C C C C SC C C C C C
PLAVIX
 N N N N N N N N N N N N N N N N N N N N N N N
PRADAXA
QP Q Q P P C Q Q C C C Q C C C C Q C C Q Q C C
PREVACID DELAYED RELEASE
 N N N N N N N N N N 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 C N N N N N N N N N
PRILOSEC
 N N N N N N N N N N N N N N N N N N N N N N N
PROCRIT
 P QP QP P P P QP QP QP P P QP P P P P QP P QP QP QP P P
PROGRAF
 P P P P P P P P P P P P P P P P P P P P P N N
PROLIA INJECTION
 P QP QP P P P QP Q C Q Q P P P Q Q Q Q QP QP QP P P
PROMETHAZINE
C P N P P C N P N P P N C P P P P P P N N P P
PROMETHAZINE HCL
C P N P P C N P N P P P C P P P P P P N N P P
PROMETHAZINE VC
C N N N N C N N N N N N C P N N N N N N N N N
PROTONIX
 N N N N N N N N N N N N N N N N N N N N N N N
PROVIGIL
QP N N N N N N N N N N N N N N N N N N N N N N
PULMICORT
 P N N N N N N N N N N N N QP N N N N P N N N N
PULMICORT FLEXHALER
C N N C C N N N Q N N N C N N N N N N N N N N
RANEXA
Q N C C C C C C C P P Q S P C C C C C Q C C P P
 AARP MedicareRx Saver Plus (PDP)
S5921-376		Aetna Medicare Rx Saver (PDP)
S5810-066		Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)
H6229-006		Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
H0148-001		Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
H0148-002		CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan)
H7885-001		CareMore Cal MediConnect Medicare-Medicaid Plan (Medicare-Medicaid Plan)
H6229-005		CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan)
H5172-002		EnvisionRxPlus Silver (PDP)
S7694-032		Health Net Cal MediConnect (Medicare-Medicaid Plan)
H3237-001		Health Net Cal MediConnect (Medicare-Medicaid Plan)
H3237-002		Humana Preferred Rx Plan (PDP)
S5884-114		IEHP DualChoice (Medicare-Medicaid Plan)
H5355-001		L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)
H8258-001		Molina Dual Options (Medicare-Medicaid Plan)
H8677-001		Molina Dual Options (Medicare-Medicaid Plan)
H8677-002		Santa Clara Family Health Plan (Medicare-Medicaid Plan)
H7890-001		SilverScript Choice (PDP)
S5601-064		Symphonix Rite Aid Value Rx (PDP)
S0522-034		CareMore Touch (HMO SNP)
H0544-005		CareMore Touch (HMO SNP)
H0544-005		SCAN Healthy at Home (HMO SNP)
H9104-006		SCAN Healthy at Home (HMO SNP)
H9104-006
RECLAST INJECTION
 P N N N N N N N N N N N N N N N N N C N N N N
REGRANEX
 P QP N QP QP QP N N P C C C N Q P P N P N N N Q Q
REQUIP
 N N N N N N N N N N N N N N N N N N N N N N N
REVATIO
QP N N P P N N QP N P P QP N N QP QP QP QP QP N N N N
RHINOCORT AQUA
 N N N N N N N N N C C N N N N N N N N N N N N
RISEDRONATE SODIUM [ACTONEL]
 N Q N QP QP C N Q Q S N N Q Q C S N N Q N N N N C SC S
RISPERDAL CONSTA
C C QP P P P QP Q C SC C Q QP P Q Q Q Q Q QP QP C C
RISPERIDONE
C Q Q Q Q P Q Q C C C Q Q C Q Q Q Q C Q Q C C
ROZEREM
 N Q Q P P Q Q C Q C C N Q N Q Q C Q Q Q Q Q Q
SANCTURA
 N N N N N N N N N N 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 N N N N N N N N N N N
SIMVASTATIN
Q Q Q C C C Q Q Q C C Q C C Q Q Q Q Q Q Q C C
SKELAXIN
 N N N N N N N N N N N N N N N N N N N N N N N
STALEVO
 N N N N N N N N N N N N N C N N N N N N N N N
TAMIFLU
Q Q Q Q Q Q Q Q Q C C Q Q Q C C Q C Q Q Q C C
TAMSULOSIN HCL
C C C Q Q C C C C C C Q Q C Q Q C Q Q C C C C
TAZICEF
C C N P P N N C N C C N N P C C C C C N N C C
TOBRAMYCIN-DEXAMETH OPTH
C C C C C C C N C C C C C C C C N C C C C C C
TRANSDERM SCOP
C C Q P P N Q Q C C C QP Q C QP QP Q QP Q Q Q C C
TRAVATAN Z
C C C Q Q N C Q C C C Q C Q C C Q C C C C N N
TRICOR
 N N N N N N N N N N N N N N N N N N N N N N N
TRILIPIX
 N N N N N N N N N N N N N C N N N N N N N N N
ULORIC
C S N N N N C S N Q SC S N N N N C SC SC SQ SC SC S N N C SC S
ULTRAM ER
 N N N N N N N N N N N N N N N N N N N N N N N
VANCOMYCIN HCL
 P P QP P P P QP C C P P C QP QPSC C C C P QP QP P P
VOLTAREN
 P Q Q P P C Q C P C C C N Q C C C C C Q Q C C
 AARP MedicareRx Saver Plus (PDP)
S5921-376		Aetna Medicare Rx Saver (PDP)
S5810-066		Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)
H6229-006		Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
H0148-001		Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
H0148-002		CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan)
H7885-001		CareMore Cal MediConnect Medicare-Medicaid Plan (Medicare-Medicaid Plan)
H6229-005		CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan)
H5172-002		EnvisionRxPlus Silver (PDP)
S7694-032		Health Net Cal MediConnect (Medicare-Medicaid Plan)
H3237-001		Health Net Cal MediConnect (Medicare-Medicaid Plan)
H3237-002		Humana Preferred Rx Plan (PDP)
S5884-114		IEHP DualChoice (Medicare-Medicaid Plan)
H5355-001		L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)
H8258-001		Molina Dual Options (Medicare-Medicaid Plan)
H8677-001		Molina Dual Options (Medicare-Medicaid Plan)
H8677-002		Santa Clara Family Health Plan (Medicare-Medicaid Plan)
H7890-001		SilverScript Choice (PDP)
S5601-064		Symphonix Rite Aid Value Rx (PDP)
S0522-034		CareMore Touch (HMO SNP)
H0544-005		CareMore Touch (HMO SNP)
H0544-005		SCAN Healthy at Home (HMO SNP)
H9104-006		SCAN Healthy at Home (HMO SNP)
H9104-006
VOLTAREN EYE DROPS
 N N N N N N N N N N 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 N N N N N N N N N N
VYTORIN
Q N N N N QP N N N N N N Q N N N N N N N N Q Q
XARELTO
QP Q Q P P Q Q C C C C Q P C C C C C C Q Q C C
XIFAXAN
 P N QP N N C QP QPSC C C QP N N P P QPS P C QP QP Q Q
XOPENEX
 N N N N N N N N N N N N N N N N N N N N N N N
XOPENEX HFA
 N N N N N C S N N N N N N N N Q Q N Q N N N N N
ZEGERID
 N N N N N N N N N C SC S N N N N N N N N N N N N
ZETIA
C Q Q P P Q SQ C C C C Q Q Q C C C C Q Q Q Q Q
ZIPRASIDONE HCL
Q Q Q Q Q C Q Q C C C Q Q C Q Q Q Q C Q Q C SC S
ZOLPIDEM TARTRATE [Ambien, Edluar, Zolpimist]
Q QP N QP QP Q N QP P P P Q Q Q QP QP QP QP Q N N P P
ZOLPIDEM TARTRATE ER [Ambien, Edluar, Zolpimist]
 N N N N N N N QP N P P N Q N N N QP N Q N N N N
ZOSYN
C N C N N C C N N N N N N P N N N N C C C C C
ZYPREXA
 N N N N N N N N N N N N N N N N N N N N N N N
ZYPREXA ZYDIS
 N N N N N N N N N N N N N N N N N N N N N N N
ZYVOX
QP QP QP P P Q QP C P C C C QP P C C C C P QP QP C C
           





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  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
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  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
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  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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