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Search 2023 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 NY

           

Key
 C Covered - No restrictions
 Q Has quantity limits
 S Has step therapy
 P Has prior authorization
 N Not Covered
Cigna Secure Rx (PDP)
S5617-013		SilverScript Choice (PDP)
S5601-006		Wellcare Classic (PDP)
S4802-077		AgeWell New York CareWell (HMO I-SNP)
H4922-004		ArchCare Advantage (HMO I-SNP)
H1777-007		Centers Plan for Nursing Home Care (HMO I-SNP)
H6988-003		Elderplan Advantage For Nursing Home Residents (HMO I-SNP)
H3347-003		Elderplan Assist (HMO I-SNP)
H3347-015		Independent Health's Medicare Family Choice (HMO I-SNP)
H3362-020		Longevity Health Plan (HMO I-SNP)
H8457-001		Nascentia Skilled Nursing Facility (HMO I-SNP)
H9066-002		RiverSpring Star (HMO I-SNP)
H6776-001		UnitedHealthcare Assisted Living Plan (PPO I-SNP)
H2292-003		UnitedHealthcare Assisted Living Plan (PPO I-SNP)
H2292-004		UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)
H3379-022		UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
H2292-001		UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
H2292-002		UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)
H3379-002
ABILIFY
 N N N N N N N N N N N Q N N N N N N
ABILIFY DISCMELT
 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 C N N N N N N
ACTONEL
 N N N N N N N N N N N Q S N N N N N N
ACTOS
 N N N N N N N N N N N Q N N N N N N
ACYCLOVIR
 P P P P P P P P P P P P P P P P P P
ACYCLOVIR SODIUM
 N N N N N N N N N N N N N N N N N N
ADVAIR DISKUS
Q Q Q Q Q Q Q Q N Q Q Q Q Q Q Q Q Q
ADVAIR HFA
Q Q Q Q Q Q Q Q C Q Q Q Q Q Q Q Q Q
AGGRENOX
 N N N N N N N N N N N N N N N N N N
ALBUTEROL SULFATE
 P P P P P QP P P P P P P P P P P P P
ALENDRONATE SODIUM
 N N N N N N N N N N N N N N N N N N
AMBIEN
 N N N N N N N N N N N Q N N N N N N
AMBIEN CR
 N N N N N N N N N N N Q N N N N N N
AMITIZA
 N N N N N N N N N Q N Q S N N N N N N
AMLODIPINE BESYLATE
 N N N N N N N N N N N N N N N N N N
APIDRA
 N N N N N N N N N N N C S N N N N N N
ARANESP ALBUMIN FREE
 N N N N N N N N P P N P P P P P P P
ARFORMOTEROL [Brovana]
 N N N N N N N N P P N P N N N N N N
ARIPIPRAZOLE [Abilify]
Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q
ARIPIPRAZOLE ODT [Abilify Discmelt]
Q Q Q Q Q Q SQ Q Q Q Q Q Q Q Q Q Q Q
ARIXTRA
 N N N N N N N N N N N C N N N N N N
ARMODAFINIL [NUVIGIL]
 N QP QP QP QP QP QP QP C QP QP QP QP QP QP QP QP QP
ASPIRIN-DIPYRIDAM [Aggrenox]
 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 C S N N N N N N
ATACAND HCT
 N N N N N N N N N N N C S N N N N N N
AVAPRO
 N N N N N N N N N N N C S N N N N N N
AVELOX
 N N N N N N N 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 N N N N N N N
AVELOX IV
 N N N N N N N N N N N N N N N N N N
 Cigna Secure Rx (PDP)
S5617-013		SilverScript Choice (PDP)
S5601-006		Wellcare Classic (PDP)
S4802-077		AgeWell New York CareWell (HMO I-SNP)
H4922-004		ArchCare Advantage (HMO I-SNP)
H1777-007		Centers Plan for Nursing Home Care (HMO I-SNP)
H6988-003		Elderplan Advantage For Nursing Home Residents (HMO I-SNP)
H3347-003		Elderplan Assist (HMO I-SNP)
H3347-015		Independent Health's Medicare Family Choice (HMO I-SNP)
H3362-020		Longevity Health Plan (HMO I-SNP)
H8457-001		Nascentia Skilled Nursing Facility (HMO I-SNP)
H9066-002		RiverSpring Star (HMO I-SNP)
H6776-001		UnitedHealthcare Assisted Living Plan (PPO I-SNP)
H2292-003		UnitedHealthcare Assisted Living Plan (PPO I-SNP)
H2292-004		UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)
H3379-022		UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
H2292-001		UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
H2292-002		UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)
H3379-002
AZATHIOPRINE
 N N N N N N N N N N N N N N N N N N
AZATHIOPRINE SODIUM
 N N N N N N N N N N N N N N N N N N
BENICAR
 N N N N N N N N N N N C S N N N N N N
BENICAR HCT
 N N N N N N N N N N N C S N N N N N N
BETASERON
QP QP QP P QP QP QP QP N QP P QP Q Q Q Q Q Q
Bimatoprost [Lumigan]
 N N N N N N N N C N N C N N N N N N
BONIVA
 N N N N N N N N N N N N N N N N N N
BROVANA
 N N N N N N N N N N N P N N N N N N
BYETTA
 N Q Q N Q N Q Q N QP N QP Q Q Q Q Q Q
BYSTOLIC
 N N N N N N N N N C N C N N N N N N
CANDESARTAN CILEXETIL [ATACAND]
Q Q Q Q Q C C C C C Q C Q Q Q Q Q Q
CARBIDOPA-LEVODOPA-ENTACAPONE [STALEVO]
 N C C C C C C C C C C C C C C C C C
CARVEDILOL
 N Q N N N N N N Q N N C N N N N N N
CEFTAZIDIME
 P C C C C C C C C C C P C C C C C C
CEFTRIAXONE
 N N N N N N N N N N N N N N N N N N
CELEBREX
 N N N N N N N N N N N C N N N N N N
CELECOXIB [Celebrex]
Q Q Q C Q Q Q Q C C C C Q Q Q Q Q Q
CELLCEPT
 N N N N N N N N N N N P N N N N N N
CHANTIX
 N N N N N N N N N N N N N N N N N N
COLCRYS
 N N N N N N N N N N N C S N N N N N N
COPAXONE
QP QP N P N QP N N N N P QP N N N N N N
COZAAR
 N N N N N N N N N N N C S N N N N N N
CUBICIN
 N N N N N N N N N N N N N N N N N N
DABIGATRAN ETEXILATE [Pradaxa]
 N Q Q N Q Q SQ Q C C N C N N N N N N
DAPTOMYCIN [Cubicin]
 N N N N N N N N N N N N N N N N N N
DARIFENACIN [Enablex]
 N N N C N N N N Q N C C N N N N N N
DEXTROSE
C C C P C P C C C C P C P P P P P P
DICLOFENAC EPOLAMINE [Flector]
 N N N N N N N N N N N N N N N N N N
DICLOFENAC SOD ER [Voltaren-XR]
C Q C C C Q C C C C C C C C C C C C
DONEPEZIL HYDROCHLORIDE
Q Q Q Q Q Q Q Q C C Q C Q Q Q Q Q Q
ELESTAT
 N N N N N N N N N N N N N N N N N N
ELIDEL
 N N N N N N N N N N N QP N N N N N N
ENABLEX
 N N N N N N N 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 N N N N N N N
EPOGEN
 N N N N N N N N P N N P N N N N N N
 Cigna Secure Rx (PDP)
S5617-013		SilverScript Choice (PDP)
S5601-006		Wellcare Classic (PDP)
S4802-077		AgeWell New York CareWell (HMO I-SNP)
H4922-004		ArchCare Advantage (HMO I-SNP)
H1777-007		Centers Plan for Nursing Home Care (HMO I-SNP)
H6988-003		Elderplan Advantage For Nursing Home Residents (HMO I-SNP)
H3347-003		Elderplan Assist (HMO I-SNP)
H3347-015		Independent Health's Medicare Family Choice (HMO I-SNP)
H3362-020		Longevity Health Plan (HMO I-SNP)
H8457-001		Nascentia Skilled Nursing Facility (HMO I-SNP)
H9066-002		RiverSpring Star (HMO I-SNP)
H6776-001		UnitedHealthcare Assisted Living Plan (PPO I-SNP)
H2292-003		UnitedHealthcare Assisted Living Plan (PPO I-SNP)
H2292-004		UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)
H3379-022		UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
H2292-001		UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
H2292-002		UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)
H3379-002
ESCITALOPRAM [LEXAPRO]
Q Q C Q C C C C C Q Q Q C C C C C C
ESOMEPRAZOLE [NEXIUM]
 N Q C SC Q SQ SQ SQ SC C C Q Q Q Q Q Q Q
ESZOPICLONE [LUNESTA]
 N N N N QP Q QP QP P N N Q Q Q Q Q Q Q
EXELON
 N N N N N N N N N N N N N N N N N N
EXELON PATCH
 N Q N N N N N N N N N C N N N N N N
Ezetimibe [Zetia]
Q C C Q C Q C C C C Q C Q Q Q Q Q Q
Ezetimibe-Simvastatin [Vytorin]
 N Q N N Q Q C C P Q N Q Q Q Q Q Q Q
FEBUXOSTAT [Uloric]
C SC S N P N Q S N N C SC P C C SC SC SC SC SC S
FENOFIBRIC ACID [TRILIPIX]
C C N Q N C N N C C Q C C C C C C C
FENTANYL PATCH
Q QP QP QP QP Q QP QP Q 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
FLECTOR PATCH
 N N N N N N N N N N N QP N N N N N N
FORTAZ
 N N N N N N N N N N N N N N N N N N
FORTEO
QP P P N P Q P P P QP N QP QP QP QP QP QP QP
FOSRENOL
 N N N N N N N N N N N Q N N N N N N
FRAGMIN
 N N N N N N N N N N N C N N N N N N
GEODON
 N N N N N N N N N C N Q N N N N N N
GLATIRAMER [Copaxone]
 N N N N N N N N N C N Q N N N N N N
HUMALOG
C N N N N N N N C C N C C C C C C C
Humalog PEN
C N N N N N N N C C S N C SC C C C C C
HUMALOG KWIKPEN INJECTION
C N N N N N N N C C N C C C C C C C
HUMALOG MIX 50/50
C N N N N N N N C C N C C C C C C C
HUMALOG MIX 75/25
C N N N N N N N C C N C C C C C C C
HUMALOG MIX KWIKPEN INJECTION
C N N N N N N N C C N C C C C C C C
IBANDRONATE SODIUM
Q Q P Q P Q P P C Q Q Q Q Q Q Q Q Q
INSPRA
 N N N N N N N N N N N C N N N N N N
INSULIN ASPART
 N N N N N N N N N N N C S N N N N N N
INSULIN ASPART [NovoLog PenFill]
 N N N N N N N N N N N C S N N N N N N
INSULIN ASPART PROT-INSULN [NovoLog Mix 70/30]
 N N N N N N N N N N N C S N N N N N N
INVEGA
Q Q Q C Q Q Q Q P Q C Q C C C C C C
IPRATROPIUM/ALBUTEROL
 N N N N N N N N N N N N N N N N N N
IPRATROPIUM BROMIDE
Q Q C Q C Q C C C Q Q Q C C C C C C
IPRATROPIUM BROMIDE NASAL
 N N N N N N N N N N N N N N N N N N
IRBESARTAN [AVAPRO]
Q Q Q Q Q C C C C C Q C Q Q Q Q Q Q
LANSOPRAZOLE ODT [Prevacid]
 N N N N N N N N N N N N N N N N N N
LANSOPRAZOLE [Prevacid]
 N N N N N N N N N N N N N N N N N N
LANTHANUM CARBONATE CHEW [Fosrenol]
 N C N N N N N N C Q N Q C C C C C C
LEUPROLIDE PREFILLED SYRINGE [LUPRON]
 N N N N N N N N N N N N N N N N N N
 Cigna Secure Rx (PDP)
S5617-013		SilverScript Choice (PDP)
S5601-006		Wellcare Classic (PDP)
S4802-077		AgeWell New York CareWell (HMO I-SNP)
H4922-004		ArchCare Advantage (HMO I-SNP)
H1777-007		Centers Plan for Nursing Home Care (HMO I-SNP)
H6988-003		Elderplan Advantage For Nursing Home Residents (HMO I-SNP)
H3347-003		Elderplan Assist (HMO I-SNP)
H3347-015		Independent Health's Medicare Family Choice (HMO I-SNP)
H3362-020		Longevity Health Plan (HMO I-SNP)
H8457-001		Nascentia Skilled Nursing Facility (HMO I-SNP)
H9066-002		RiverSpring Star (HMO I-SNP)
H6776-001		UnitedHealthcare Assisted Living Plan (PPO I-SNP)
H2292-003		UnitedHealthcare Assisted Living Plan (PPO I-SNP)
H2292-004		UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)
H3379-022		UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
H2292-001		UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
H2292-002		UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)
H3379-002
LEVEMIR
C C C C C N C C C C SC C SC C C C C C
LEXAPRO
 N N N N N N N N N N N Q 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
LIDODERM PATCH
 N N N N N N N N N N N QP N N N N N N
LINEZOLID [Zyvox]
QP QP Q P Q C Q Q C C P P Q Q Q Q Q Q
LOTEMAX
C C C N C Q C C C C N C C C C C C C
LOTEPREDNOL ETABONATE [LOTEMAX]
C C N C N N N N C C C C C C C C C C
LOVAZA
 N N N N N N N N N N N N N N N N N N
LOVENOX
 N N N N N N N N N N N Q N N N N N N
LUBIPROSTONE [Amitiza]
 N N N Q N Q N N Q Q Q Q Q Q Q Q Q Q
LUMIGAN
C C C C C Q C C C C C C C C C C C C
LUNESTA
 N N N N N N N N N N N Q N N N N N N
LUPRON DEPOT
 P P P P P P P P P P P P P P P P P P
MEGACE ES
 N N N N N N N N N N N N N N N N N N
MEGACE ORAL
 N N N N N N N N N N N N N N N N N N
MELOXICAM
C C C C C C C C C C C C C C C C C C
Memantine HCl [Namenda]
QP QP P Q P Q P P C P Q P QP QP QP QP QP QP
Memantine HCl [Namenda Titration]
QP QP N Q P N P P C P Q P QP QP QP QP QP QP
MIACALCIN
 N N N N N N N N N N N N N N N N N N
MORPHINE
 N N N N N N N N N N N N N N N N N N
MORPHINE SULFATE
 N QP N N N N N N C N N QP N N N N N N
MOXIFLOXACIN HCL [AVELOX]
 N N N N N N N N N N N N N N N N N N
NAMENDA
 N N N N N N N N N N N P N N N N N N
NASONEX
 N N N N N N N N N N N N N N N N N N
NEBIVOLOL [Bystolic]
C Q Q C Q C Q Q C C C C Q Q Q Q Q Q
NEUPOGEN
 N N N N N N N N P P N P N N N N N N
NEXIUM
 N N N N N N N N N N N Q N N N N N N
NEXIUM IV
 N N N N N N N N N N N N N N N N N N
NITRO-BID
 N C C C C N C C C C C C C C C C C C
NOVOLOG
 N C C C C Q C C N N C C S N N N N N N
NOVOLOG FLEXPEN
 N C C C C Q C C N N C C S N N N N N N
NOVOLOG MIX 70/30
 N C C C C Q C C N N C C S N N N N N N
NUVIGIL
 N N N N N N N N N N N QP N N N N N N
 Cigna Secure Rx (PDP)
S5617-013		SilverScript Choice (PDP)
S5601-006		Wellcare Classic (PDP)
S4802-077		AgeWell New York CareWell (HMO I-SNP)
H4922-004		ArchCare Advantage (HMO I-SNP)
H1777-007		Centers Plan for Nursing Home Care (HMO I-SNP)
H6988-003		Elderplan Advantage For Nursing Home Residents (HMO I-SNP)
H3347-003		Elderplan Assist (HMO I-SNP)
H3347-015		Independent Health's Medicare Family Choice (HMO I-SNP)
H3362-020		Longevity Health Plan (HMO I-SNP)
H8457-001		Nascentia Skilled Nursing Facility (HMO I-SNP)
H9066-002		RiverSpring Star (HMO I-SNP)
H6776-001		UnitedHealthcare Assisted Living Plan (PPO I-SNP)
H2292-003		UnitedHealthcare Assisted Living Plan (PPO I-SNP)
H2292-004		UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)
H3379-022		UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
H2292-001		UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
H2292-002		UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)
H3379-002
OLMESARTAN MEDOXOMIL [Benicar]
C Q Q Q Q C C C C C Q C Q Q Q Q Q Q
OMEGA-3 ETHYL ESTERS [Lovaza]
 N N N C N Q S N N C C C C Q Q Q Q Q Q
OMEPRAZOLE [Prilosec]
 N N N N N N N 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 N N N N N N N
ONDANSETRON
 N N N N N N N N N N N N N N N N N N
ONDANSETRON HCL
 N N N N N N N N N N N N N N N N N N
ONDANSETRON ODT
 P P C P P P P P P P P P P P P P P P
ONGLYZA
 N N N N N N N N N N N Q N N N N N N
Oseltamivir Phosphate [Tamiflu]
C Q Q C Q Q Q Q C C C C Q Q Q Q Q Q
OXYCONTIN
 N QP N N N Q N N C 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 N N N N N N N
PANTOPRAZOLE [Protonix]
Q Q C C C Q C C C C C C Q Q Q Q Q Q
PANTOPRAZOLE SODIUM
 N N N N N N N N N N N N N N N N N N
PATADAY
 N N N N N N N N N N N N N N N N N N
PIMECROLIMUS [Elidel]
 N N N C N Q N N C QP C QP Q SQ SQ SQ SQ SQ S
PLAVIX
 N N N N N N N N N N N Q N N N N N N
PRADAXA
 N N Q N Q N Q Q C N N P N N N N N N
PREVACID DELAYED RELEASE
 N N N N N N N N N N N C N N N N N N
PREVACID SOLUTAB
 N N N N N N N N N N N Q N N N N N N
PRILOSEC
 N N N N N N N N N Q N Q N N N N N N
PROCRIT
 P P P N P N P P P P N P P P P P P P
PROGRAF
 P P P P P PS P P P P P P P P P P P P
PROLIA INJECTION
Q Q Q Q Q Q Q Q P QP Q QP Q Q Q Q Q Q
PROMETHAZINE
 P P P C P P P P P P C P C C C C C C
PROMETHAZINE HCL
 N P N C N P N N P C C N Q Q Q Q Q Q
PROMETHAZINE VC
 N N N N N N N N N N N N N N N N N N
PROTONIX
 N N N N N N N N N N N Q N N N N N N
PROVIGIL
 N N N N N N N N N N N QP N N N N N N
PULMICORT
 N N N N N N N N N N N QP N N N N N N
PULMICORT FLEXHALER
 N Q Q N Q N Q Q C N N Q N N N N N N
RAMELTEON [Rozerem]
 N Q Q N Q N Q Q C N N Q N N N N N N
RANEXA
 N N N N N N N N N N N N N N N N N N
RANOLAZINE [Ranexa]
Q C C C C Q C C C C C C Q Q Q Q Q Q
 Cigna Secure Rx (PDP)
S5617-013		SilverScript Choice (PDP)
S5601-006		Wellcare Classic (PDP)
S4802-077		AgeWell New York CareWell (HMO I-SNP)
H4922-004		ArchCare Advantage (HMO I-SNP)
H1777-007		Centers Plan for Nursing Home Care (HMO I-SNP)
H6988-003		Elderplan Advantage For Nursing Home Residents (HMO I-SNP)
H3347-003		Elderplan Assist (HMO I-SNP)
H3347-015		Independent Health's Medicare Family Choice (HMO I-SNP)
H3362-020		Longevity Health Plan (HMO I-SNP)
H8457-001		Nascentia Skilled Nursing Facility (HMO I-SNP)
H9066-002		RiverSpring Star (HMO I-SNP)
H6776-001		UnitedHealthcare Assisted Living Plan (PPO I-SNP)
H2292-003		UnitedHealthcare Assisted Living Plan (PPO I-SNP)
H2292-004		UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)
H3379-022		UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
H2292-001		UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
H2292-002		UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)
H3379-002
RECLAST INJECTION
 N N N N N N N N N N N N N N N N N N
REGRANEX
 P QP QP P QP N QP QP C C P C P P P P P P
REQUIP
 N N N N N N N N N N N N N N N N N N
REVATIO
 N N N N N N N N N N N QP N N N N N N
RHINOCORT AQUA
 N N N N N N N N N N N N N N N N N N
RISEDRONATE SODIUM [ACTONEL]
 N Q N Q C Q C C C Q Q Q Q Q Q Q Q Q
RISPERDAL CONSTA
Q Q Q C Q Q Q Q P Q C Q C C C C C C
RISPERIDONE
Q Q Q Q Q C Q Q Q Q Q Q C C C C C C
ROZEREM
 N N N N N N N N N N N Q N N N N N N
SANCTURA
 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
SCOPOLAMINE TD [Transderm Scop]
Q QP QP C QP QP QP QP C C C C C C C C C C
SIMVASTATIN
Q Q Q Q Q Q C C C Q Q Q Q Q Q Q Q Q
SKELAXIN
 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 C N N N N N N
TAMIFLU
 N N N N N N N N N N N C N N N N N N
TAMSULOSIN HCL
 N N N N N N N N N N N N N N N N N N
TAZICEF
 P C C N C N C C N C N P C C C C C C
TOBRAMYCIN-DEXAMETH OPTH
C C C C C C C C C Q C Q C C C C C C
TRANSDERM SCOP
 N N N N N N N N N C N C N N N N N N
TRAVATAN Z
 N N N N N N N N N N N N N N N N N N
TRAVOPROST [Travatan]
 N N N N N N N N N N N N N N N N N N
TRICOR
 N N N N N N N N N N N C N N N N N N
TRILIPIX
 N N N N N N N N N N N C N N N N N N
ULORIC
 N N N N N N N N N N N C N N N N N N
ULTRAM ER
 N N N N N N N N N N N N N N N N N N
VANCOMYCIN HCL
C C C C C C C C C C C QP C C C C C C
VOLTAREN
 N N N N N N N N N N N N N N N N N N
 Cigna Secure Rx (PDP)
S5617-013		SilverScript Choice (PDP)
S5601-006		Wellcare Classic (PDP)
S4802-077		AgeWell New York CareWell (HMO I-SNP)
H4922-004		ArchCare Advantage (HMO I-SNP)
H1777-007		Centers Plan for Nursing Home Care (HMO I-SNP)
H6988-003		Elderplan Advantage For Nursing Home Residents (HMO I-SNP)
H3347-003		Elderplan Assist (HMO I-SNP)
H3347-015		Independent Health's Medicare Family Choice (HMO I-SNP)
H3362-020		Longevity Health Plan (HMO I-SNP)
H8457-001		Nascentia Skilled Nursing Facility (HMO I-SNP)
H9066-002		RiverSpring Star (HMO I-SNP)
H6776-001		UnitedHealthcare Assisted Living Plan (PPO I-SNP)
H2292-003		UnitedHealthcare Assisted Living Plan (PPO I-SNP)
H2292-004		UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)
H3379-022		UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
H2292-001		UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
H2292-002		UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)
H3379-002
VOLTAREN EYE DROPS
 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
VYTORIN
 N N N N N N N N N N N Q S N N N N N N
XARELTO
 N N N N N N N N N N N N N N N N N N
XIFAXAN
QP P P C P QP P P Q Q C Q P P P P P P
XOPENEX
 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 N N N N N N Q S N N N N N N
ZEGERID
 N N N N N N N N N N N Q N N N N N N
ZETIA
 N N N N N N N N N N N C N N N N N N
ZIPRASIDONE HCL
Q Q Q Q Q C Q Q C Q Q Q Q Q Q Q Q Q
ZOLPIDEM TARTRATE [Ambien, Edluar, Zolpimist]
 N N N N N N N 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 N N N N N N N
ZOSYN
 N N N N N N N N N C N C N N N N N N
ZYPREXA
 N N N N N N N N N N N Q N N N N N N
ZYPREXA ZYDIS
 N N N N N N N N N N N Q N N N N N N
ZYVOX
 N N N N N N N N N N N P N N N N N N
           





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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.
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  • 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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