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Search 2017 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 MI

           

Key
 C Covered - No restrictions
 Q Has quantity limits
 S Has step therapy
 P Has prior authorization
 N Not Covered
Aetna Medicare Rx Saver (PDP)
S5810-047		Basic Blue Rx (PDP)
S6986-001		Cigna-HealthSpring Rx Secure (PDP)
S5617-221		EnvisionRxPlus (PDP)
S7694-070		Humana Preferred Rx Plan (PDP)
S5884-136		SilverScript Choice (PDP)
S5601-026		Symphonix Value Rx (PDP)
S0522-018		WellCare Classic (PDP)
S4802-084		Erickson Advantage Guardian (HMO-POS SNP)
H5652-003
ABILIFY
C Q QP C SQ Q C Q C
ABILIFY DISCMELT
 N N N N N N N N N
ACIPHEX
 N N N N N N N N N
ACTONEL
 N N N N N N N N N
ACTOS
 N N N N N N N N N
ACYCLOVIR
 P P QP P P P P P QP
ACYCLOVIR SODIUM
 N N N N N N N N N
ADVAIR DISKUS
Q Q Q Q N Q N Q Q
ADVAIR HFA
Q Q Q Q N Q N Q Q
AGGRENOX
 N C Q S N N C N N QP
ALBUTEROL SULFATE
 P P QP P P P P P P
ALENDRONATE SODIUM
Q Q Q Q Q C Q Q Q
AMBIEN
 N N N N N N N N N
AMBIEN CR
 N N N N N N N N N
AMITIZA
Q Q Q Q N Q N Q Q
AMLODIPINE BESYLATE
Q C Q Q Q C C C Q
APIDRA
 N N N N N N N N N
ARANESP ALBUMIN FREE
QP N QP N N N P N P
ARIPIPRAZOLE [Abilify]
Q Q Q SQ Q Q Q Q Q
ARIXTRA
 N N N N N N N N N
ARMODAFINIL [NUVIGIL]
QP QP QP QP QP QP N QP N
ASPIRIN-DIPYRIDAM [Aggrenox]
 N N N N N N N N N
ATACAND
 N N N N N N N N N
ATACAND HCT
 N N N N N N N N N
AVAPRO
 N N N N N N N N N
AVELOX
 N N N N N N N N N
AVELOX ABC PACK
 N N N N N N N N N
AVELOX IV
 N N C N N N C N C
 Aetna Medicare Rx Saver (PDP)
S5810-047		Basic Blue Rx (PDP)
S6986-001		Cigna-HealthSpring Rx Secure (PDP)
S5617-221		EnvisionRxPlus (PDP)
S7694-070		Humana Preferred Rx Plan (PDP)
S5884-136		SilverScript Choice (PDP)
S5601-026		Symphonix Value Rx (PDP)
S0522-018		WellCare Classic (PDP)
S4802-084		Erickson Advantage Guardian (HMO-POS SNP)
H5652-003
AZATHIOPRINE
 N N N N N N N N N
AZATHIOPRINE SODIUM
 P P P P P P P P P
BENICAR
 N N Q S N N N N N Q
BENICAR HCT
 N N Q S N N N N N Q
BETASERON
 N QP QP Q QP QP N QP C
Bimatoprost [Lumigan]
 N N Q N N N N N N
BONIVA
 N N N N N N N N N
BROVANA
 N N N N QP N N N QP
BYETTA
Q Q Q Q N Q Q Q Q
BYSTOLIC
Q C Q N N C N C Q
CANDESARTAN CILEXETIL [ATACAND]
Q N Q Q Q N N N Q
CARBIDOPA-LEVODOPA-ENTACAPONE [STALEVO]
C N C C N C C N C
CARVEDILOL
C C C C C C C C C
CEFTAZIDIME
C C C C C C C C C
CEFTRIAXONE
C C C C C C C C C
CELEBREX
 N N N N N N N N N
CELECOXIB [Celebrex]
Q Q Q C N Q N Q Q
CELLCEPT
 P N P N P N P N P
CHANTIX
Q P Q P Q C C C C
COLCRYS
 N Q N N Q Q N Q QP
COPAXONE
QP QP QP Q QP QP C QP C
COZAAR
 N N N N N N N N N
CUBICIN
C C P N C C C C C
DAPTOMYCIN [Cubicin]
C C P C C C C C C
DARIFENACIN [Enablex]
 N N Q C N N N N N
DEXTROSE
C C P C C C C C C
DONEPEZIL HYDROCHLORIDE
Q Q Q Q Q Q Q Q Q
ELESTAT
 N N N N N N N N N
ELIDEL
Q S N Q C SC N C S N C S
ENABLEX
 N N Q S N N N N N N
ENOXAPARIN SODIUM INJECTION
C C Q Q Q C Q C Q
EPOGEN
 N N N N QP N N N N
 Aetna Medicare Rx Saver (PDP)
S5810-047		Basic Blue Rx (PDP)
S6986-001		Cigna-HealthSpring Rx Secure (PDP)
S5617-221		EnvisionRxPlus (PDP)
S7694-070		Humana Preferred Rx Plan (PDP)
S5884-136		SilverScript Choice (PDP)
S5601-026		Symphonix Value Rx (PDP)
S0522-018		WellCare Classic (PDP)
S4802-084		Erickson Advantage Guardian (HMO-POS SNP)
H5652-003
ESCITALOPRAM [LEXAPRO]
Q Q Q Q Q C C Q C
ESOMEPRAZOLE [NEXIUM]
 N Q Q C N C N C Q
ESZOPICLONE [LUNESTA]
 N N N N Q N N N N
EXELON
 N N N N N N N N N
EXELON PATCH
 N Q N N Q Q N N N
Ezetimibe [Zetia]
Q C Q Q N C Q C Q
Ezetimibe-Simvastatin [Vytorin]
 N N Q N N N N N Q
FENOFIBRIC ACID [TRILIPIX]
C N Q N Q N N N C
FENTANYL PATCH
Q QP Q Q SQ Q Q Q Q
FEXOFENADINE HCL
 N N N N N N N N N
FLECTOR PATCH
 N N N N N N N N QP
FORTAZ
 N N N N N N N N N
FORTEO
QP QP QP QP Q SQP N QP QP
FOSRENOL
C N N N N N N N C
FRAGMIN
 N N N N Q N N N N
GEODON
C Q Q Q SC Q C Q C
HUMALOG
 N N C N N N C N C
Humalog PEN
 N N C N N N C N C
HUMALOG KWIKPEN INJECTION
 N N C N N N C N C
HUMALOG MIX 50/50
 N N C N N N C N C
HUMALOG MIX 75/25
 N N C N N N C N C
HUMALOG MIX KWIKPEN INJECTION
 N N C N N N C N C
IBANDRONATE SODIUM
Q N Q Q N N Q QP QP
INSPRA
 N N N N N N N N N
INVEGA
C Q Q Q SQ Q P Q P
IPRATROPIUM/ALBUTEROL
 N N N N N N N N N
IPRATROPIUM BROMIDE
QP P QP QP QP P P P P
IPRATROPIUM BROMIDE NASAL
 N N N N N N N N N
IRBESARTAN [AVAPRO]
Q C Q Q Q C Q C Q
LANSOPRAZOLE TABLETS DR
 N N N N N N N N N
LEUPROLIDE PREFILLED SYRINGE [LUPRON]
 N N N N N N N N N
 Aetna Medicare Rx Saver (PDP)
S5810-047		Basic Blue Rx (PDP)
S6986-001		Cigna-HealthSpring Rx Secure (PDP)
S5617-221		EnvisionRxPlus (PDP)
S7694-070		Humana Preferred Rx Plan (PDP)
S5884-136		SilverScript Choice (PDP)
S5601-026		Symphonix Value Rx (PDP)
S0522-018		WellCare Classic (PDP)
S4802-084		Erickson Advantage Guardian (HMO-POS SNP)
H5652-003
LEVEMIR
C C C C C C N C C
LEXAPRO
 N N N N N N N N N
LIDOCAINE DCL 1% VIAL
 N N N N N N N N N
LIDODERM PATCH
 N N N N N N N N N
LINEZOLID [Zyvox]
QP C Q P C C QP C QP
LOTEMAX
C C C C N C N C C
LOVAZA
 N N N N N N N N N
LOVENOX
 N N N N N N N N N
LUMIGAN
C C Q SC Q C N C C
LUNESTA
 N N N N N N N N N
LUPRON DEPOT
 P P QP QP N P P P P
MEGACE ES
 N N N N N N N N N
MEGACE ORAL
 N N N N N N N N N
MELOXICAM
C C Q C Q C C C C
Memantine HCl [Namenda]
QP P QP Q QP P QP P QP
Memantine HCl [Namenda Titration]
QP N QP C QP N N N P
MIACALCIN
C P C P C P P P P
MORPHINE
 P P Q N Q P C P C
MORPHINE SULFATE
Q Q Q Q Q Q Q Q Q
MOXIFLOXACIN HCL [AVELOX]
 N N Q N N N C N C
NAMENDA
QP P QP P QP P QP P QP
NASONEX
Q Q N N N Q N N P
NEUPOGEN
 P P QP QP QP P N P P
NEXIUM
 N Q N C N C N C Q
NEXIUM IV
 N N N N N N N N N
NITRO-BID
 N C N N N C C C C
NOVOLOG
C C N C C C N C N
NOVOLOG FLEXPEN
C C N C C C N C N
NOVOLOG MIX 70/30
C C N C C C N C N
NUVIGIL
 N N QP QP N N N N N
 Aetna Medicare Rx Saver (PDP)
S5810-047		Basic Blue Rx (PDP)
S6986-001		Cigna-HealthSpring Rx Secure (PDP)
S5617-221		EnvisionRxPlus (PDP)
S7694-070		Humana Preferred Rx Plan (PDP)
S5884-136		SilverScript Choice (PDP)
S5601-026		Symphonix Value Rx (PDP)
S0522-018		WellCare Classic (PDP)
S4802-084		Erickson Advantage Guardian (HMO-POS SNP)
H5652-003
OLMESARTAN MEDOXOMIL [Benicar]
 N C Q C N C N C Q
OMEGA-3 ETHYL ESTERS [Lovaza]
Q C Q C N C N C Q
OMEPRAZOLE
Q Q Q Q Q C Q C Q
ONDANSETRON
C C C C C C C C C
ONDANSETRON HCL
QP P QP QP QP C P C P
ONDANSETRON ODT
 P P QP P QP C P C P
ONGLYZA
 N N N N Q N Q N Q
Oseltamivir Phosphate [Tamiflu]
Q C Q Q Q C Q C Q
OXYCONTIN
 N N N N N Q N N N
PALIPERIDONE (24 HR) ER [INVEGA]
 N N N N N N N N N
PANTOPRAZOLE SODIUM
Q Q Q Q Q C Q C Q
PATADAY
C C Q C C C N C C
PLAVIX
 N N N N N N N N N
PRADAXA
Q C Q C Q C QP C QP
PREVACID DELAYED RELEASE
 N N N N N N N N N
PREVACID SOLUTAB
 N N N N N N N N N
PRILOSEC
 N N N N N N N N P
PROCRIT
QP P QP QP QP P N P P
PROGRAF
 P P P N P P P P P
PROLIA INJECTION
Q Q Q SQ Q Q C Q C
PROMETHAZINE
 P P P P C P C P C
PROMETHAZINE HCL
 P P P P C P C P C
PROMETHAZINE VC
 N N N N N N N N N
PROTONIX
 N N N N C N N N N
PROVIGIL
 N N N N N N N N N
PULMICORT
 N N N N N N N N N
PULMICORT FLEXHALER
 N Q N N N Q Q Q N
RANEXA
Q C Q Q SQ SC Q C Q
 Aetna Medicare Rx Saver (PDP)
S5810-047		Basic Blue Rx (PDP)
S6986-001		Cigna-HealthSpring Rx Secure (PDP)
S5617-221		EnvisionRxPlus (PDP)
S7694-070		Humana Preferred Rx Plan (PDP)
S5884-136		SilverScript Choice (PDP)
S5601-026		Symphonix Value Rx (PDP)
S0522-018		WellCare Classic (PDP)
S4802-084		Erickson Advantage Guardian (HMO-POS SNP)
H5652-003
RECLAST INJECTION
 N N N N N N N N N
REGRANEX
QP P QP P C P P P P
REQUIP
 N N N N N N N N N
REVATIO
 N QP N N QP QP N QP QP
RHINOCORT AQUA
 N N N N N N N N N
RISEDRONATE SODIUM [ACTONEL]
Q N N N Q N N N Q
RISPERDAL CONSTA
C Q Q C Q Q C Q C
RISPERIDONE
Q Q Q Q Q C C Q C
ROZEREM
Q N Q N N N N N Q
SANCTURA
 N N N N N N N N N
SANCTURA XR
 N N N N N N N N N
SIMVASTATIN
Q Q Q Q Q Q Q Q Q
SKELAXIN
 N N N N N N N N N
STALEVO
 N N N N N N N N P
TAMIFLU
Q C Q Q Q C Q C Q
TAMSULOSIN HCL
C C Q Q Q C C C C
TAZICEF
C C C N N C C C C
TOBRAMYCIN-DEXAMETH OPTH
C C C C C C C C C
TRANSDERM SCOP
C QP Q Q Q QP C QP C
TRAVATAN Z
C C Q C Q C C C C
TRICOR
 N N N N N N N N N
TRILIPIX
 N N N N N N N N N
ULORIC
C SC SQ S N N C SC SC SC S
ULTRAM ER
 N N N N N N N N N
VANCOMYCIN HCL
Q C Q C C C C C C
VOLTAREN
Q C Q N C C N N P
 Aetna Medicare Rx Saver (PDP)
S5810-047		Basic Blue Rx (PDP)
S6986-001		Cigna-HealthSpring Rx Secure (PDP)
S5617-221		EnvisionRxPlus (PDP)
S7694-070		Humana Preferred Rx Plan (PDP)
S5884-136		SilverScript Choice (PDP)
S5601-026		Symphonix Value Rx (PDP)
S0522-018		WellCare Classic (PDP)
S4802-084		Erickson Advantage Guardian (HMO-POS SNP)
H5652-003
VOLTAREN EYE DROPS
 N N N N N N N N N
VOLTAREN-XR
 N N N N N N N N N
VYTORIN
 N N Q N N N N N Q
XARELTO
Q C Q C Q C QP C QP
XIFAXAN
 N P QP N QP P P P P
XOPENEX
 N N N N N N N N N
XOPENEX HFA
 N N N N N Q N N N
ZEGERID
 N N N N N N N N N
ZETIA
Q N Q Q Q N Q N Q
ZIPRASIDONE HCL
Q Q Q Q Q C Q Q Q
ZOLPIDEM TARTRATE [Ambien, Edluar, Zolpimist]
QP QP QP QP Q QP Q QP Q
ZOLPIDEM TARTRATE ER [Ambien, Edluar, Zolpimist]
 N N N N Q N N N N
ZOSYN
 N N C C N N N N N
ZYPREXA
 N N N N N N N N N
ZYPREXA ZYDIS
 N N N N N N N N N
ZYVOX
 N N N N C N N N N
           





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