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Search 2024 Top Long-Term Care Prescription Drugs

 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 NE

           

Key
 C Covered - No restrictions
 Q Has quantity limits
 S Has step therapy
 P Has prior authorization
 N Not Covered
AARP Medicare Rx Basic from UHC (PDP)
S5921-370		Clear Spring Health Value Rx (PDP)
S6946-022		Mutual of Omaha Rx Plus (PDP)
S7126-024		SilverScript Choice (PDP)
S5601-050		Wellcare Classic (PDP)
S4802-089		Great Plains Medicare Advantage (HMO I-SNP)
H7511-001		Great Plains Medicare Advantage Gold (HMO I-SNP)
H7511-002
ABILIFY
 N N N N N N N
ABILIFY DISCMELT
 N N N N N N N
ACIPHEX
 N N N N N N N
ACTONEL
 N N N N N N N
ACTOS
 N N N N N N N
ACYCLOVIR
 P N P P P P P
ACYCLOVIR SODIUM
 N N N N N N N
ADVAIR DISKUS
 N N N N N N N
ADVAIR HFA
 N N N Q Q Q Q
AGGRENOX
 N N N N N N N
ALBUTEROL SULFATE
 P N P P P QP QP
ALENDRONATE SODIUM
 N N N N N N N
AMBIEN
 N N N N N N N
AMBIEN CR
 N N N N N N N
AMITIZA
 N N N N N N N
AMLODIPINE BESYLATE
 N N N N N N N
APIDRA
 N N N N N N N
ARANESP ALBUMIN FREE
 P N N N N N N
ARFORMOTEROL [Brovana]
QP N QP N N QP QP
ARIPIPRAZOLE [Abilify]
Q N Q Q Q Q Q
ARIPIPRAZOLE ODT [Abilify Discmelt]
Q N Q Q Q Q Q
ARIXTRA
 N N N N N N N
ARMODAFINIL [NUVIGIL]
QP N QP QP QP QP QP
ASPIRIN-DIPYRIDAM [Aggrenox]
 N N N N N N N
ATACAND
 N N N N N N N
ATACAND HCT
 N N N N N N N
AVAPRO
 N N N N N N N
AVELOX
 N N N N N N N
AVELOX ABC PACK
 N N N N N N N
AVELOX IV
 N N N N N N N
 AARP Medicare Rx Basic from UHC (PDP)
S5921-370		Clear Spring Health Value Rx (PDP)
S6946-022		Mutual of Omaha Rx Plus (PDP)
S7126-024		SilverScript Choice (PDP)
S5601-050		Wellcare Classic (PDP)
S4802-089		Great Plains Medicare Advantage (HMO I-SNP)
H7511-001		Great Plains Medicare Advantage Gold (HMO I-SNP)
H7511-002
AZATHIOPRINE
 N N N N N N N
AZATHIOPRINE SODIUM
 N N N N N N N
BENICAR
 N N N N N N N
BENICAR HCT
 N N N N N N N
BETASERON
 N N QP QP QP QP QP
Bimatoprost [Lumigan]
 N N N N N N N
BONIVA
 N N N N N N N
BROVANA
 N N N N N N N
BYETTA
 N N N QP N QP QP
BYSTOLIC
 N N N N N N N
CANDESARTAN CILEXETIL [ATACAND]
Q N Q Q Q C C
CARBIDOPA-LEVODOPA-ENTACAPONE [STALEVO]
C N C C C N N
CARVEDILOL
 N N N Q N N N
CEFTAZIDIME
C N P C C C C
CEFTRIAXONE
 N N N N N N N
CELEBREX
 N N N N N N N
CELECOXIB [Celebrex]
 N N C Q Q Q Q
CELLCEPT
 N N N N N N N
CHANTIX
 N N N N N N N
COLCRYS
 N N N N N N N
COPAXONE
 N N N QP N N N
COZAAR
 N N N N N N N
CUBICIN
 N N N N N N N
DABIGATRAN ETEXILATE [Pradaxa]
Q N C Q Q N N
DAPTOMYCIN [Cubicin]
 N N N N N N N
DARIFENACIN [Enablex]
 N N N N N N N
DEXTROSE
 P N C C C C C
DICLOFENAC EPOLAMINE [Flector]
 N N N N N N N
DICLOFENAC SOD ER [Voltaren-XR]
C N C Q C C C
DONEPEZIL HYDROCHLORIDE
Q N C Q Q C C
ELESTAT
 N N N N N N N
ELIDEL
 N N N N N N N
ENABLEX
 N N N N N N N
ENOXAPARIN SODIUM INJECTION
 N N N N N N N
EPOGEN
 N N N N N N N
 AARP Medicare Rx Basic from UHC (PDP)
S5921-370		Clear Spring Health Value Rx (PDP)
S6946-022		Mutual of Omaha Rx Plus (PDP)
S7126-024		SilverScript Choice (PDP)
S5601-050		Wellcare Classic (PDP)
S4802-089		Great Plains Medicare Advantage (HMO I-SNP)
H7511-001		Great Plains Medicare Advantage Gold (HMO I-SNP)
H7511-002
EPINASTINE HCL [Elestat]
 N N C C N N N
 AARP Medicare Rx Basic from UHC (PDP)
S5921-370		Clear Spring Health Value Rx (PDP)
S6946-022		Mutual of Omaha Rx Plus (PDP)
S7126-024		SilverScript Choice (PDP)
S5601-050		Wellcare Classic (PDP)
S4802-089		Great Plains Medicare Advantage (HMO I-SNP)
H7511-001		Great Plains Medicare Advantage Gold (HMO I-SNP)
H7511-002
ESCITALOPRAM [LEXAPRO]
C N Q Q C C C
ESOMEPRAZOLE [NEXIUM]
 N N Q N Q Q Q
ESZOPICLONE [LUNESTA]
 N N N N N Q Q
EXELON
 N N N N N N N
EXELON PATCH
 N N N Q N N N
Ezetimibe [Zetia]
Q N C C C C C
Ezetimibe-Simvastatin [Vytorin]
 N N Q Q N C C
FEBUXOSTAT [Uloric]
C S N C C S N C C
FENOFIBRIC ACID [TRILIPIX]
 N N C C N C C
FENTANYL PATCH
Q N QP QP QP N N
FEXOFENADINE HCL
 N N N N N N N
FLECTOR PATCH
 N N N N N N N
FORTAZ
 N N N N N N N
FORTEO
 N N N N P P P
FOSRENOL
 N N N N N N N
FRAGMIN
 N N N N N C C
GEODON
 N N N N N N N
GLATIRAMER [Copaxone]
 N N N N N N N
HUMALOG
C N C N N C C
Humalog PEN
C N C N N C C
HUMALOG KWIKPEN INJECTION
C N C N N C C
HUMALOG MIX 50/50
 N N N N N N N
HUMALOG MIX 75/25
C N C N N C C
HUMALOG MIX KWIKPEN INJECTION
C N C N N C C
IBANDRONATE SODIUM
Q N Q Q Q Q Q
INSPRA
 N N N N N N N
INSULIN ASPART
 N N N N N N N
INSULIN ASPART [NovoLog PenFill]
 N N N N N N N
INSULIN ASPART PROT-INSULN [NovoLog Mix 70/30]
 N N N N N N N
INVEGA
C N Q Q Q C C
IPRATROPIUM/ALBUTEROL
 N N N N N N N
IPRATROPIUM BROMIDE
 N N N N N N N
IPRATROPIUM BROMIDE NASAL
 N N N N N N N
IRBESARTAN [AVAPRO]
Q N Q Q Q C C
LANSOPRAZOLE ODT [Prevacid]
 N N N N N N N
LANSOPRAZOLE [Prevacid]
 N N N N N N N
LANTHANUM CARBONATE CHEW [Fosrenol]
 N N N C N N N
LEUPROLIDE PREFILLED SYRINGE [LUPRON]
 N N N N N N N
 AARP Medicare Rx Basic from UHC (PDP)
S5921-370		Clear Spring Health Value Rx (PDP)
S6946-022		Mutual of Omaha Rx Plus (PDP)
S7126-024		SilverScript Choice (PDP)
S5601-050		Wellcare Classic (PDP)
S4802-089		Great Plains Medicare Advantage (HMO I-SNP)
H7511-001		Great Plains Medicare Advantage Gold (HMO I-SNP)
H7511-002
LEVEMIR
 N N N N N C C
LEXAPRO
 N N N N N N N
LIDOCAINE DCL 1% VIAL
 N N N N N N N
LIDODERM PATCH
 N N N N N N N
LINEZOLID [Zyvox]
Q N P QP Q Q Q
LOTEMAX
 N N N C C Q Q
LOTEPREDNOL ETABONATE [LOTEMAX]
 N N N C N N N
LOVAZA
 N N N N N N N
LOVENOX
 N N N N N N N
LUBIPROSTONE [Amitiza]
 N N Q N N Q Q
LUMIGAN
 N N N C C Q Q
LUNESTA
 N N N N N N N
LUPRON DEPOT
QP N P P P QP QP
MEGACE ES
 N N N N N N N
MEGACE ORAL
 N N N N N N N
MELOXICAM
C N Q C Q C C
Memantine HCl [Namenda]
QP N P QP P C C
Memantine HCl [Namenda Titration]
QP N N QP N C C
MIACALCIN
 N N N N N N N
MORPHINE
 N N N N N N N
MORPHINE SULFATE
 N N N Q N N N
MOXIFLOXACIN HCL [AVELOX]
 N N N N N N N
NAMENDA
 N N N N N N N
NASONEX
 N N N N N N N
NEBIVOLOL [Bystolic]
 N N C Q Q C C
NEUPOGEN
 N N N N N N N
NEXIUM
 N N N N N N N
NEXIUM IV
 N N N N N N N
NITRO-BID
C N C C C C C
NOVOLOG
 N N N N N C C
NOVOLOG FLEXPEN
 N N N N N C C
NOVOLOG MIX 70/30
 N N N C C C C
NUVIGIL
 N N N N N N N
 AARP Medicare Rx Basic from UHC (PDP)
S5921-370		Clear Spring Health Value Rx (PDP)
S6946-022		Mutual of Omaha Rx Plus (PDP)
S7126-024		SilverScript Choice (PDP)
S5601-050		Wellcare Classic (PDP)
S4802-089		Great Plains Medicare Advantage (HMO I-SNP)
H7511-001		Great Plains Medicare Advantage Gold (HMO I-SNP)
H7511-002
OLMESARTAN MEDOXOMIL [Benicar]
Q N Q Q Q C C
OMEGA-3 ETHYL ESTERS [Lovaza]
Q N C QP N C C
OMEPRAZOLE [Prilosec]
 N N N N N N N
OMEPRAZOLE-BICARBONATE [Zegerid]
 N N N N N N N
ONDANSETRON
 N N N N N N N
ONDANSETRON HCL
 N N N N N N N
ONDANSETRON ODT
QP N P P C P P
ONGLYZA
 N N N N N N N
Oseltamivir Phosphate [Tamiflu]
Q N C Q Q Q Q
OXYCONTIN
 N N N QP N N N
PALIPERIDONE (24 HR) ER [INVEGA]
 N N N N N N N
PANTOPRAZOLE [Protonix]
Q N Q Q Q Q Q
PANTOPRAZOLE SODIUM
 N N N N N N N
PATADAY
 N N N N N N N
PIMECROLIMUS [Elidel]
 N N N N N N N
PLAVIX
 N N N N N N N
PRADAXA
 N N N N Q N N
PREVACID DELAYED RELEASE
 N N N N N N N
PREVACID SOLUTAB
 N N N N N N N
PRILOSEC
 N N N N N N N
PROCRIT
 P N P P P P P
PROGRAF
 P N P P P P P
PROLIA INJECTION
Q N QP Q Q Q Q
PROMETHAZINE
C N P P P C C
PROMETHAZINE HCL
 N N N P N C C
PROMETHAZINE VC
 N N N N N N N
PROTONIX
 N N N N N N N
PROVIGIL
 N N N N N N N
PULMICORT
 N N N N N N N
PULMICORT FLEXHALER
Q N N N Q N N
RAMELTEON [Rozerem]
Q N N N Q N N
RANEXA
 N N N N N N N
RANOLAZINE [Ranexa]
Q N C C C C C
 AARP Medicare Rx Basic from UHC (PDP)
S5921-370		Clear Spring Health Value Rx (PDP)
S6946-022		Mutual of Omaha Rx Plus (PDP)
S7126-024		SilverScript Choice (PDP)
S5601-050		Wellcare Classic (PDP)
S4802-089		Great Plains Medicare Advantage (HMO I-SNP)
H7511-001		Great Plains Medicare Advantage Gold (HMO I-SNP)
H7511-002
RECLAST INJECTION
 N N N N N N N
REGRANEX
 P N Q QP Q N N
REQUIP
 N N N N N N N
REVATIO
 N N N N N N N
RHINOCORT AQUA
 N N N N N N N
RISEDRONATE SODIUM [ACTONEL]
 N N N Q N Q Q
RISPERDAL CONSTA
C N N Q Q C C
RISPERIDONE
C N Q Q Q Q Q
ROZEREM
 N N N N N N N
SANCTURA
 N N N N N N N
SANCTURA XR
 N N N N N N N
SAXAGLIPTIN [ONGLYZA]
 N N Q N N N N
SCOPOLAMINE TD [Transderm Scop]
C N C QP QP C C
SIMVASTATIN
Q N Q Q Q C C
SKELAXIN
 N N N N N N N
STALEVO
 N N N N N N N
TAMIFLU
 N N N N N N N
TAMSULOSIN HCL
 N N N N N N N
TAZICEF
C N P C C C C
TOBRAMYCIN-DEXAMETH OPTH
C N Q C C C C
TRANSDERM SCOP
 N N N N N N N
TRAVATAN Z
 N N N N N N N
TRAVOPROST [Travatan]
 N N N N N N N
TRICOR
 N N N N N N N
TRILIPIX
 N N N N N N N
ULORIC
 N N N N N N N
ULTRAM ER
 N N N N N N N
VANCOMYCIN HCL
C N QP C C C C
VOLTAREN
 N N N N N N N
 AARP Medicare Rx Basic from UHC (PDP)
S5921-370		Clear Spring Health Value Rx (PDP)
S6946-022		Mutual of Omaha Rx Plus (PDP)
S7126-024		SilverScript Choice (PDP)
S5601-050		Wellcare Classic (PDP)
S4802-089		Great Plains Medicare Advantage (HMO I-SNP)
H7511-001		Great Plains Medicare Advantage Gold (HMO I-SNP)
H7511-002
VOLTAREN EYE DROPS
 N N N N N N N
VOLTAREN-XR
 N N N N N N N
VYTORIN
 N N N N N N N
XARELTO
 N N N N N N N
XIFAXAN
 P N Q P QP P P
XOPENEX
 N N N N N N N
XOPENEX HFA
 N N N N N N N
ZEGERID
 N N N N N N N
ZETIA
 N N N N N N N
ZIPRASIDONE HCL
Q N Q Q Q Q Q
ZOLPIDEM TARTRATE [Ambien, Edluar, Zolpimist]
 N N N N N N N
ZOLPIDEM TARTRATE ER [Ambien, Edluar, Zolpimist]
 N N N N N N N
ZOSYN
 N N N N N N N
ZYPREXA
 N N N N N N N
ZYPREXA ZYDIS
 N N N N N N N
ZYVOX
 N N N N N N N
           





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