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Search 2022 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 HI

           

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)
S5921-381		Cigna Secure Rx (PDP)
S5617-163		Clear Spring Health Value Rx (PDP)
S6946-028		SilverScript Choice (PDP)
S5601-066		Wellcare Classic (PDP)
S4802-095
ABILIFY
 N N N N N
ABILIFY DISCMELT
 N N N N N
ACIPHEX
 N N N N N
ACTONEL
 N N N N N
ACTOS
 N N N N N
ACYCLOVIR
 N N P N P
ACYCLOVIR SODIUM
 N N N N N
ADVAIR DISKUS
 N N Q N Q
ADVAIR HFA
 N N Q N Q
AGGRENOX
 N N N N N
ALBUTEROL SULFATE
 N N C N C
ALENDRONATE SODIUM
 N N N N N
AMBIEN
 N N N N N
AMBIEN CR
 N N N N N
AMITIZA
 N N N N N
AMLODIPINE BESYLATE
 N N N N N
APIDRA
 N N N N N
ARANESP ALBUMIN FREE
 N N N N N
ARFORMOTEROL [Brovana]
 N N P N N
ARIPIPRAZOLE [Abilify]
 N N Q N Q
ARIPIPRAZOLE ODT [Abilify Discmelt]
 N N Q N Q
ARIXTRA
 N N N N N
ARMODAFINIL [NUVIGIL]
 N N QP N QP
ASPIRIN-DIPYRIDAM [Aggrenox]
 N N N N N
ATACAND
 N N N N N
ATACAND HCT
 N N N N N
AVAPRO
 N N N N N
AVELOX
 N N N N N
AVELOX ABC PACK
 N N N N N
AVELOX IV
 N N N N N
 AARP MedicareRx Saver Plus (PDP)
S5921-381		Cigna Secure Rx (PDP)
S5617-163		Clear Spring Health Value Rx (PDP)
S6946-028		SilverScript Choice (PDP)
S5601-066		Wellcare Classic (PDP)
S4802-095
AZATHIOPRINE
 N N N N N
AZATHIOPRINE SODIUM
 N N N N N
BENICAR
 N N N N N
BENICAR HCT
 N N N N N
BETASERON
 N N QP N QP
Bimatoprost [Lumigan]
 N N N N N
BONIVA
 N N N N N
BROVANA
 N N N N N
BYETTA
 N N N N Q
BYSTOLIC
 N N N N Q
CANDESARTAN CILEXETIL [ATACAND]
 N N Q N N
CARBIDOPA-LEVODOPA-ENTACAPONE [STALEVO]
 N N C N C
CARVEDILOL
 N N N N N
CEFTAZIDIME
 N N P N C
CEFTRIAXONE
 N N C N C
CELEBREX
 N N N N N
CELECOXIB [Celebrex]
 N N C N Q
CELLCEPT
 N N N N N
CHANTIX
 N N N N N
COLCRYS
 N N C N N
COPAXONE
 N N QP N N
COZAAR
 N N N N N
CUBICIN
 N N N N N
DAPTOMYCIN [Cubicin]
 N N N N N
DARIFENACIN [Enablex]
 N N C N N
DEXTROSE
 N N C N C
DICLOFENAC EPOLAMINE [Flector]
 N N N N N
DICLOFENAC SOD ER [Voltaren-XR]
 N N C N C
DONEPEZIL HYDROCHLORIDE
 N N C N Q
ELESTAT
 N N N N N
ELIDEL
 N N N N N
ENABLEX
 N N N N N
ENOXAPARIN SODIUM INJECTION
 N N N N N
EPOGEN
 N N N N N
 AARP MedicareRx Saver Plus (PDP)
S5921-381		Cigna Secure Rx (PDP)
S5617-163		Clear Spring Health Value Rx (PDP)
S6946-028		SilverScript Choice (PDP)
S5601-066		Wellcare Classic (PDP)
S4802-095
ESCITALOPRAM [LEXAPRO]
 N N Q N C
ESOMEPRAZOLE [NEXIUM]
 N N C N C S
ESZOPICLONE [LUNESTA]
 N N N N N
EXELON
 N N N N N
EXELON PATCH
 N N N N N
Ezetimibe [Zetia]
 N N C N C
Ezetimibe-Simvastatin [Vytorin]
 N N Q N N
FEBUXOSTAT [Uloric]
 N N C N N
FENOFIBRIC ACID [TRILIPIX]
 N N N N N
FENTANYL PATCH
 N N QP N QP
FEXOFENADINE HCL
 N N N N N
FLECTOR PATCH
 N N N N N
FORTAZ
 N N N N N
FORTEO
 N N N N P
FOSRENOL
 N N N N N
FRAGMIN
 N N N N N
GEODON
 N N Q S N N
GLATIRAMER [Copaxone]
 N N Q S N N
HUMALOG
 N N N N N
Humalog PEN
 N N N N N
HUMALOG KWIKPEN INJECTION
 N N N N N
HUMALOG MIX 50/50
 N N N N N
HUMALOG MIX 75/25
 N N N N N
HUMALOG MIX KWIKPEN INJECTION
 N N N N N
IBANDRONATE SODIUM
 N N Q N P
INSPRA
 N N N N N
INSULIN ASPART
 N N N N N
INSULIN ASPART [NovoLog PenFill]
 N N N N N
INSULIN ASPART PROT-INSULN [NovoLog Mix 70/30]
 N N N N N
INVEGA
 N N Q N Q
IPRATROPIUM/ALBUTEROL
 N N N N N
IPRATROPIUM BROMIDE
 N N Q N C
IPRATROPIUM BROMIDE NASAL
 N N N N N
IRBESARTAN [AVAPRO]
 N N Q N Q
LANSOPRAZOLE ODT [Prevacid]
 N N N N N
LANSOPRAZOLE [Prevacid]
 N N N N N
LANTHANUM CARBONATE CHEW [Fosrenol]
 N N N N N
LEUPROLIDE PREFILLED SYRINGE [LUPRON]
 N N N N N
 AARP MedicareRx Saver Plus (PDP)
S5921-381		Cigna Secure Rx (PDP)
S5617-163		Clear Spring Health Value Rx (PDP)
S6946-028		SilverScript Choice (PDP)
S5601-066		Wellcare Classic (PDP)
S4802-095
LEVEMIR
 N N C N C
LEXAPRO
 N N N N N
LIDOCAINE DCL 1% VIAL
 N N N N N
LIDODERM PATCH
 N N N N N
LINEZOLID [Zyvox]
 N N P N Q
LOTEMAX
 N N N N C
LOTEPREDNOL ETABONATE [LOTEMAX]
 N N C N N
LOVAZA
 N N N N N
LOVENOX
 N N N N N
LUBIPROSTONE [Amitiza]
 N N N N N
LUMIGAN
 N N N N C
LUNESTA
 N N N N N
LUPRON DEPOT
 N N P N P
MEGACE ES
 N N N N N
MEGACE ORAL
 N N N N N
MELOXICAM
 N N C N C
Memantine HCl [Namenda]
 N N QP N P
Memantine HCl [Namenda Titration]
 N N P N N
MIACALCIN
 N N N N N
MORPHINE
 N N N N N
MORPHINE SULFATE
 N N N N N
MOXIFLOXACIN HCL [AVELOX]
 N N N N N
NAMENDA
 N N N N N
NASONEX
 N N N N N
NEBIVOLOL [Bystolic]
 N N N N Q
NEUPOGEN
 N N P N N
NEXIUM
 N N N N N
NEXIUM IV
 N N N N N
NITRO-BID
 N N C N C
NOVOLOG
 N N C N C
NOVOLOG FLEXPEN
 N N C N C
NOVOLOG MIX 70/30
 N N C N C
NUVIGIL
 N N N N N
 AARP MedicareRx Saver Plus (PDP)
S5921-381		Cigna Secure Rx (PDP)
S5617-163		Clear Spring Health Value Rx (PDP)
S6946-028		SilverScript Choice (PDP)
S5601-066		Wellcare Classic (PDP)
S4802-095
OLMESARTAN MEDOXOMIL [Benicar]
 N N C N Q
OMEGA-3 ETHYL ESTERS [Lovaza]
 N N C N N
OMEPRAZOLE [Prilosec]
 N N N N N
OMEPRAZOLE-BICARBONATE [Zegerid]
 N N N N N
ONDANSETRON
 N N N N N
ONDANSETRON HCL
 N N N N N
ONDANSETRON ODT
 N N P N C
ONGLYZA
 N N N N N
Oseltamivir Phosphate [Tamiflu]
 N N C N Q
OXYCONTIN
 N N N N QP
PALIPERIDONE (24 HR) ER [INVEGA]
 N N N N N
PANTOPRAZOLE [Protonix]
 N N C N C
PANTOPRAZOLE SODIUM
 N N N N N
PATADAY
 N N N N N
PIMECROLIMUS [Elidel]
 N N QPS N N
PLAVIX
 N N N N N
PRADAXA
 N N C N Q
PREVACID DELAYED RELEASE
 N N N N N
PREVACID SOLUTAB
 N N N N N
PRILOSEC
 N N N N N
PROCRIT
 N N QP N P
PROGRAF
 N N P N P
PROLIA INJECTION
 N N QP N Q
PROMETHAZINE
 N N P N P
PROMETHAZINE HCL
 N N N N N
PROMETHAZINE VC
 N N N N N
PROTONIX
 N N N N N
PROVIGIL
 N N N N N
PULMICORT
 N N N N N
PULMICORT FLEXHALER
 N N N N Q
RAMELTEON [Rozerem]
 N N N N Q
RANEXA
 N N N N N
RANOLAZINE [Ranexa]
 N N Q N C
 AARP MedicareRx Saver Plus (PDP)
S5921-381		Cigna Secure Rx (PDP)
S5617-163		Clear Spring Health Value Rx (PDP)
S6946-028		SilverScript Choice (PDP)
S5601-066		Wellcare Classic (PDP)
S4802-095
RECLAST INJECTION
 N N N N N
REGRANEX
 N N P N QP
REQUIP
 N N N N N
REVATIO
 N N N N N
RHINOCORT AQUA
 N N N N N
RISEDRONATE SODIUM [ACTONEL]
 N N Q N N
RISPERDAL CONSTA
 N N Q N Q
RISPERIDONE
 N N Q N Q
ROZEREM
 N N N N N
SANCTURA
 N N N N N
SANCTURA XR
 N N N N N
SCOPOLAMINE TD [Transderm Scop]
 N N C N QP
SIMVASTATIN
 N N Q N Q
SKELAXIN
 N N N N N
STALEVO
 N N N N N
TAMIFLU
 N N N N N
TAMSULOSIN HCL
 N N N N N
TAZICEF
 N N N N C
TOBRAMYCIN-DEXAMETH OPTH
 N N Q N C
TRANSDERM SCOP
 N N N N N
TRAVATAN Z
 N N N N N
TRAVOPROST [Travatan]
 N N C N N
TRICOR
 N N N N N
TRILIPIX
 N N N N N
ULORIC
 N N N N N
ULTRAM ER
 N N N N N
VANCOMYCIN HCL
 N N QP N C
VOLTAREN
 N N N N N
 AARP MedicareRx Saver Plus (PDP)
S5921-381		Cigna Secure Rx (PDP)
S5617-163		Clear Spring Health Value Rx (PDP)
S6946-028		SilverScript Choice (PDP)
S5601-066		Wellcare Classic (PDP)
S4802-095
VOLTAREN EYE DROPS
 N N N N N
VOLTAREN-XR
 N N N N N
VYTORIN
 N N N N N
XARELTO
 N N N N N
XIFAXAN
 N N Q N P
XOPENEX
 N N N N N
XOPENEX HFA
 N N N N N
ZEGERID
 N N N N N
ZETIA
 N N N N N
ZIPRASIDONE HCL
 N N Q N Q
ZOLPIDEM TARTRATE [Ambien, Edluar, Zolpimist]
 N N N N N
ZOLPIDEM TARTRATE ER [Ambien, Edluar, Zolpimist]
 N N N N N
ZOSYN
 N N N N N
ZYPREXA
 N N N N N
ZYPREXA ZYDIS
 N N N N N
ZYVOX
 N N N N N
           





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