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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 MO

           

Key
 C Covered - No restrictions
 Q Has quantity limits
 S Has step therapy
 P Has prior authorization
 N Not Covered
Cigna Secure Rx (PDP)
S5617-088		Clear Spring Health Value Rx (PDP)
S6946-015		Humana Basic Rx Plan (PDP)
S5884-140		SilverScript Choice (PDP)
S5601-036		Wellcare Classic (PDP)
S4802-072		American Health Advantage of Missouri (HMO I-SNP)
H4490-001		American Health Advantage of Missouri Choice (HMO I-SNP)
H4490-003		American Health Advantage of Missouri Premier (HMO I-SNP)
H4490-002		NHC Advantage (HMO I-SNP)
H4172-001		Provider Partners Missouri Advantage Plan (HMO I-SNP)
H9191-001		UnitedHealthcare Nursing Home Plan (PPO I-SNP)
H0710-016
ABILIFY
 N N N N N N N N N N N
ABILIFY DISCMELT
 N N N N N N N N N N N
ACIPHEX
 N N N N N N N N N N N
ACTONEL
 N N N N N N N N N N N
ACTOS
 N N N N N N N N N N N
ACYCLOVIR
 N P P N P P P P P P N
ACYCLOVIR SODIUM
 N N N N N N N N N N N
ADVAIR DISKUS
 N Q N N Q C C C Q C N
ADVAIR HFA
 N Q N N Q C C C Q C N
AGGRENOX
 N N N N N N N N N N N
ALBUTEROL SULFATE
 N C Q N C C C C C C N
ALENDRONATE SODIUM
 N N N N N N N N N N N
AMBIEN
 N N N N N N N N N N N
AMBIEN CR
 N N N N N N N N N N N
AMITIZA
 N N N N N N N N C N N
AMLODIPINE BESYLATE
 N N N N N N N N N N N
APIDRA
 N N N N N N N N N N N
ARANESP ALBUMIN FREE
 N N N N N N N N P N N
ARFORMOTEROL [Brovana]
 N P N N N P P P QP N N
ARIPIPRAZOLE [Abilify]
 N Q Q N Q C C C C QP N
ARIPIPRAZOLE ODT [Abilify Discmelt]
 N Q Q N Q C C C Q QP N
ARIXTRA
 N N N N N N N N N N N
ARMODAFINIL [NUVIGIL]
 N QP N N QP QP QP QP QP QP N
ASPIRIN-DIPYRIDAM [Aggrenox]
 N N N N N N N N N N N
ATACAND
 N N N N N N N N N N N
ATACAND HCT
 N N N N N N N N N N N
AVAPRO
 N N N N N N N N N N N
AVELOX
 N N N N N N N N N N N
AVELOX ABC PACK
 N N N N N N N N N N N
AVELOX IV
 N N N N N N N N N N N
 Cigna Secure Rx (PDP)
S5617-088		Clear Spring Health Value Rx (PDP)
S6946-015		Humana Basic Rx Plan (PDP)
S5884-140		SilverScript Choice (PDP)
S5601-036		Wellcare Classic (PDP)
S4802-072		American Health Advantage of Missouri (HMO I-SNP)
H4490-001		American Health Advantage of Missouri Choice (HMO I-SNP)
H4490-003		American Health Advantage of Missouri Premier (HMO I-SNP)
H4490-002		NHC Advantage (HMO I-SNP)
H4172-001		Provider Partners Missouri Advantage Plan (HMO I-SNP)
H9191-001		UnitedHealthcare Nursing Home Plan (PPO I-SNP)
H0710-016
AZATHIOPRINE
 N N N N N N N N N N N
AZATHIOPRINE SODIUM
 N N N N N N N N N N N
BENICAR
 N N N N N N N N N N N
BENICAR HCT
 N N N N N N N N N N N
BETASERON
 N QP QP N QP P P P N P N
Bimatoprost [Lumigan]
 N N N N N C C C Q C N
BONIVA
 N N N N N N N N N N N
BROVANA
 N N N N N N N N N N N
BYETTA
 N N N N Q N N N N N N
BYSTOLIC
 N N N N Q N N N N N N
CANDESARTAN CILEXETIL [ATACAND]
 N Q Q N N C C C C C N
CARBIDOPA-LEVODOPA-ENTACAPONE [STALEVO]
 N C Q N C C C C C C N
CARVEDILOL
 N N N N N N N N N N N
CEFTAZIDIME
 N P C N C C C C C C N
CEFTRIAXONE
 N C C N C C C C C C N
CELEBREX
 N N N N N N N N N N N
CELECOXIB [Celebrex]
 N C Q N Q C C C Q C N
CELLCEPT
 N N P N N N N N N N N
CHANTIX
 N N N N N N N N N N N
COLCRYS
 N C N N N N N N N N N
COPAXONE
 N QP QP N N P P P N P N
COZAAR
 N N N N N N N N N N N
CUBICIN
 N N N N N N N N N N N
DAPTOMYCIN [Cubicin]
 N N N N N N N N N N N
DARIFENACIN [Enablex]
 N C N N N C C C N C N
DEXTROSE
 N C C N C C C C P C N
DICLOFENAC EPOLAMINE [Flector]
 N N N N N N N N N N N
DICLOFENAC SOD ER [Voltaren-XR]
 N C C N C C C C C C N
DONEPEZIL HYDROCHLORIDE
 N C Q N Q C C C Q C N
ELESTAT
 N N N N N N N N N N N
ELIDEL
 N N N N N N N N N N N
ENABLEX
 N N N N N N N N N N N
ENOXAPARIN SODIUM INJECTION
 N N N N N N N N N N N
EPOGEN
 N N N N N N N N P N N
 Cigna Secure Rx (PDP)
S5617-088		Clear Spring Health Value Rx (PDP)
S6946-015		Humana Basic Rx Plan (PDP)
S5884-140		SilverScript Choice (PDP)
S5601-036		Wellcare Classic (PDP)
S4802-072		American Health Advantage of Missouri (HMO I-SNP)
H4490-001		American Health Advantage of Missouri Choice (HMO I-SNP)
H4490-003		American Health Advantage of Missouri Premier (HMO I-SNP)
H4490-002		NHC Advantage (HMO I-SNP)
H4172-001		Provider Partners Missouri Advantage Plan (HMO I-SNP)
H9191-001		UnitedHealthcare Nursing Home Plan (PPO I-SNP)
H0710-016
ESCITALOPRAM [LEXAPRO]
 N Q Q N C C C C C C N
ESOMEPRAZOLE [NEXIUM]
 N C N N C SC C C C C N
ESZOPICLONE [LUNESTA]
 N N N N N Q Q Q Q N N
EXELON
 N N N N N N N N N N N
EXELON PATCH
 N N N N N N N N N N N
Ezetimibe [Zetia]
 N C Q N C C C C Q C N
Ezetimibe-Simvastatin [Vytorin]
 N Q Q N N C C C N C N
FEBUXOSTAT [Uloric]
 N C N N N C C C C S P N
FENOFIBRIC ACID [TRILIPIX]
 N N N N N C C C C C N
FENTANYL PATCH
 N QP Q N QP QP QP QP Q QP N
FEXOFENADINE HCL
 N N N N N N N N N N N
FLECTOR PATCH
 N N N N N N N N N N N
FORTAZ
 N N N N N N N N N N N
FORTEO
 N N QP N P N N N Q N N
FOSRENOL
 N N N N N N N N C N N
FRAGMIN
 N N N N N N N N C N N
GEODON
 N Q S N N N N N N N N N
GLATIRAMER [Copaxone]
 N Q S N N N N N N N N N
HUMALOG
 N N N N N N N N N N N
Humalog PEN
 N N N N N N N N N N N
HUMALOG KWIKPEN INJECTION
 N N N N N N N N N N N
HUMALOG MIX 50/50
 N N N N N N N N N N N
HUMALOG MIX 75/25
 N N N N N N N N N N N
HUMALOG MIX KWIKPEN INJECTION
 N N N N N N N N N N N
IBANDRONATE SODIUM
 N Q N N P C C C Q C N
INSPRA
 N N N N N N N N N N N
INSULIN ASPART
 N N N N N C C C N C N
INSULIN ASPART [NovoLog PenFill]
 N N N N N C C C N C N
INSULIN ASPART PROT-INSULN [NovoLog Mix 70/30]
 N N N N N C C C N C N
INVEGA
 N Q Q N Q C C C QP Q N
IPRATROPIUM/ALBUTEROL
 N N N N N N N N N N N
IPRATROPIUM BROMIDE
 N Q Q N C C C C C C N
IPRATROPIUM BROMIDE NASAL
 N N N N N N N N N N N
IRBESARTAN [AVAPRO]
 N Q Q N Q C C C C C N
LANSOPRAZOLE ODT [Prevacid]
 N N N N N C C C N C N
LANSOPRAZOLE [Prevacid]
 N N N N N N N N N N N
LANTHANUM CARBONATE CHEW [Fosrenol]
 N N N N N C C C C C N
LEUPROLIDE PREFILLED SYRINGE [LUPRON]
 N N N N N N N N N N N
 Cigna Secure Rx (PDP)
S5617-088		Clear Spring Health Value Rx (PDP)
S6946-015		Humana Basic Rx Plan (PDP)
S5884-140		SilverScript Choice (PDP)
S5601-036		Wellcare Classic (PDP)
S4802-072		American Health Advantage of Missouri (HMO I-SNP)
H4490-001		American Health Advantage of Missouri Choice (HMO I-SNP)
H4490-003		American Health Advantage of Missouri Premier (HMO I-SNP)
H4490-002		NHC Advantage (HMO I-SNP)
H4172-001		Provider Partners Missouri Advantage Plan (HMO I-SNP)
H9191-001		UnitedHealthcare Nursing Home Plan (PPO I-SNP)
H0710-016
LEVEMIR
 N C C N C C C C C C N
LEXAPRO
 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
LIDODERM PATCH
 N N N N N N N N N N N
LINEZOLID [Zyvox]
 N P Q N Q C C C P P N
LOTEMAX
 N N C N C N N N C N N
LOTEPREDNOL ETABONATE [LOTEMAX]
 N C N N N C C C C C N
LOVAZA
 N N N N N N N N N N N
LOVENOX
 N N N N N N N N N N N
LUBIPROSTONE [Amitiza]
 N N N N N C C C C C N
LUMIGAN
 N N Q N C C C C Q C N
LUNESTA
 N N N N N N N N N N N
LUPRON DEPOT
 N P QP N P P P P Q P N
MEGACE ES
 N N N N N N N N N N N
MEGACE ORAL
 N N N N N N N N N N N
MELOXICAM
 N C Q N C C C C C C N
Memantine HCl [Namenda]
 N QP QP N P C C C C C N
Memantine HCl [Namenda Titration]
 N P QP N N C C C C C N
MIACALCIN
 N N N N N N N N N N N
MORPHINE
 N N N N N N N N N N N
MORPHINE SULFATE
 N N N N N C C C N C N
MOXIFLOXACIN HCL [AVELOX]
 N N N N N N N N N N N
NAMENDA
 N N N N N N N N N N N
NASONEX
 N N N N N N N N N N N
NEBIVOLOL [Bystolic]
 N N Q N Q C C C C C N
NEUPOGEN
 N P N N N N N N N N N
NEXIUM
 N N N N N N N N C N N
NEXIUM IV
 N N N N N N N N N N N
NITRO-BID
 N C N N C C C C C C N
NOVOLOG
 N C C N C C C C C C N
NOVOLOG FLEXPEN
 N C C N C C C C C C N
NOVOLOG MIX 70/30
 N C C N C C C C C C N
NUVIGIL
 N N N N N N N N N N N
 Cigna Secure Rx (PDP)
S5617-088		Clear Spring Health Value Rx (PDP)
S6946-015		Humana Basic Rx Plan (PDP)
S5884-140		SilverScript Choice (PDP)
S5601-036		Wellcare Classic (PDP)
S4802-072		American Health Advantage of Missouri (HMO I-SNP)
H4490-001		American Health Advantage of Missouri Choice (HMO I-SNP)
H4490-003		American Health Advantage of Missouri Premier (HMO I-SNP)
H4490-002		NHC Advantage (HMO I-SNP)
H4172-001		Provider Partners Missouri Advantage Plan (HMO I-SNP)
H9191-001		UnitedHealthcare Nursing Home Plan (PPO I-SNP)
H0710-016
OLMESARTAN MEDOXOMIL [Benicar]
 N C Q N Q C C C C C N
OMEGA-3 ETHYL ESTERS [Lovaza]
 N C N N N C C C C C N
OMEPRAZOLE [Prilosec]
 N N N N N N N N N N N
OMEPRAZOLE-BICARBONATE [Zegerid]
 N N N N N N N N N N N
ONDANSETRON
 N N N N N N N N N N N
ONDANSETRON HCL
 N N N N N N N N N N N
ONDANSETRON ODT
 N P QP N C P P P P P N
ONGLYZA
 N N N N N N N N N N N
Oseltamivir Phosphate [Tamiflu]
 N C Q N Q C C C Q C N
OXYCONTIN
 N N N N QP N N N N N N
PALIPERIDONE (24 HR) ER [INVEGA]
 N N N N N N N N N N N
PANTOPRAZOLE [Protonix]
 N C Q N C C C C C C N
PANTOPRAZOLE SODIUM
 N N N N N N N N N N N
PATADAY
 N N N N N N N N N N N
PIMECROLIMUS [Elidel]
 N QPSQP N N C C C Q C N
PLAVIX
 N N N N N N N N N N N
PRADAXA
 N C Q N Q N N N N N N
PREVACID DELAYED RELEASE
 N N N N N N N N N N N
PREVACID SOLUTAB
 N N N N N N N N N N N
PRILOSEC
 N N N N N N N N N N N
PROCRIT
 N QP QP N P P P P N N N
PROGRAF
 N P P N P P P P P P N
PROLIA INJECTION
 N QP Q N Q C C C QP C N
PROMETHAZINE
 N P C N P C C C C C N
PROMETHAZINE HCL
 N N N N N C C C C C N
PROMETHAZINE VC
 N N N N N N N N N N N
PROTONIX
 N N N N N N N N N N N
PROVIGIL
 N N N N N N N N N N N
PULMICORT
 N N N N N N N N N N N
PULMICORT FLEXHALER
 N N N N Q N N N N N N
RAMELTEON [Rozerem]
 N N N N Q N N N N N N
RANEXA
 N N N N N N N N N N N
RANOLAZINE [Ranexa]
 N Q Q N C C C C C C N
 Cigna Secure Rx (PDP)
S5617-088		Clear Spring Health Value Rx (PDP)
S6946-015		Humana Basic Rx Plan (PDP)
S5884-140		SilverScript Choice (PDP)
S5601-036		Wellcare Classic (PDP)
S4802-072		American Health Advantage of Missouri (HMO I-SNP)
H4490-001		American Health Advantage of Missouri Choice (HMO I-SNP)
H4490-003		American Health Advantage of Missouri Premier (HMO I-SNP)
H4490-002		NHC Advantage (HMO I-SNP)
H4172-001		Provider Partners Missouri Advantage Plan (HMO I-SNP)
H9191-001		UnitedHealthcare Nursing Home Plan (PPO I-SNP)
H0710-016
RECLAST INJECTION
 N N N N N N N N N N N
REGRANEX
 N P P N QP P P P QP P N
REQUIP
 N N N N N N N N N N N
REVATIO
 N N N N N N N N N N N
RHINOCORT AQUA
 N N N N N N N N N N N
RISEDRONATE SODIUM [ACTONEL]
 N Q N N N C C C C C N
RISPERDAL CONSTA
 N Q Q N Q C C C QP Q N
RISPERIDONE
 N Q Q N Q C C C C QP N
ROZEREM
 N N N N N N N N N N N
SANCTURA
 N N N N N N N N N N N
SANCTURA XR
 N N N N N N N N N N N
SCOPOLAMINE TD [Transderm Scop]
 N C Q N QP C C C C C N
SIMVASTATIN
 N Q C N Q C C C C C N
SKELAXIN
 N N N N N N N N N N N
STALEVO
 N N N N N N N N C N N
TAMIFLU
 N N N N N N N N N N N
TAMSULOSIN HCL
 N N N N N N N N N N N
TAZICEF
 N N N N C N N N C N N
TOBRAMYCIN-DEXAMETH OPTH
 N Q C N C C C C C C N
TRANSDERM SCOP
 N N N N N N N N N N N
TRAVATAN Z
 N N N N N N N N N N N
TRAVOPROST [Travatan]
 N C N N N C C C Q C N
TRICOR
 N N N N N N N N N N N
TRILIPIX
 N N N N N N N N N N N
ULORIC
 N N N N N N N N N N N
ULTRAM ER
 N N N N N N N N N N N
VANCOMYCIN HCL
 N QP C N C C C C C C N
VOLTAREN
 N N N N N N N N N N N
 Cigna Secure Rx (PDP)
S5617-088		Clear Spring Health Value Rx (PDP)
S6946-015		Humana Basic Rx Plan (PDP)
S5884-140		SilverScript Choice (PDP)
S5601-036		Wellcare Classic (PDP)
S4802-072		American Health Advantage of Missouri (HMO I-SNP)
H4490-001		American Health Advantage of Missouri Choice (HMO I-SNP)
H4490-003		American Health Advantage of Missouri Premier (HMO I-SNP)
H4490-002		NHC Advantage (HMO I-SNP)
H4172-001		Provider Partners Missouri Advantage Plan (HMO I-SNP)
H9191-001		UnitedHealthcare Nursing Home Plan (PPO I-SNP)
H0710-016
VOLTAREN EYE DROPS
 N N N N N N N N N N N
VOLTAREN-XR
 N N N N N N N N N N N
VYTORIN
 N N N N N N N N N N N
XARELTO
 N N N N N N N N N N N
XIFAXAN
 N Q QP N P C C C QP C N
XOPENEX
 N N N N N N N N N N N
XOPENEX HFA
 N N N N N N N N Q S N N
ZEGERID
 N N N N N N N N N N N
ZETIA
 N N N N N N N N N N N
ZIPRASIDONE HCL
 N Q C N Q C C C C QP N
ZOLPIDEM TARTRATE [Ambien, Edluar, Zolpimist]
 N N N N N N N N N N N
ZOLPIDEM TARTRATE ER [Ambien, Edluar, Zolpimist]
 N N N N N N N N N N N
ZOSYN
 N N N N N C C C C C N
ZYPREXA
 N N N N N N N N N N N
ZYPREXA ZYDIS
 N N N N N N N N N N N
ZYVOX
 N N N N N N N N N N N
           





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  • 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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