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Search 2025 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 NM

           

Key
 C Covered - No restrictions
 Q Has quantity limits
 S Has step therapy
 P Has prior authorization
 N Not Covered
AARP Medicare Rx Saver from UHC (PDP)
S5921-371		Cigna Healthcare Assurance Rx (PDP)
S5617-128		Humana Basic Rx Plan (PDP)
S5884-110		Wellcare Classic (PDP)
S4802-090		Humana Together in Health (PPO I-SNP)
H5216-444
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
 P P P P P
ACYCLOVIR SODIUM
 N N N N N
ADVAIR DISKUS
 N N N N QP
ADVAIR HFA
 N Q N Q Q
AGGRENOX
 N N N N N
ALBUTEROL SULFATE
 P P P P P
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
 P N N N N
ARFORMOTEROL [Brovana]
QP P N N QP
ARIPIPRAZOLE [Abilify]
Q Q Q Q Q
ARIPIPRAZOLE ODT [Abilify Discmelt]
Q Q Q Q Q
ARIXTRA
 N N N N N
ARMODAFINIL [NUVIGIL]
QP N N QP N
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 Medicare Rx Saver from UHC (PDP)
S5921-371		Cigna Healthcare Assurance Rx (PDP)
S5617-128		Humana Basic Rx Plan (PDP)
S5884-110		Wellcare Classic (PDP)
S4802-090		Humana Together in Health (PPO I-SNP)
H5216-444
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
Q QP N QP 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 N
BYSTOLIC
 N N N N N
CANDESARTAN CILEXETIL [ATACAND]
C Q Q Q Q
CARBIDOPA-LEVODOPA-ENTACAPONE [STALEVO]
C N C C C
CARVEDILOL
 N N N N N
CEFTAZIDIME
C P C C C
CEFTRIAXONE
 N N N N N
CELEBREX
 N N N N N
CELECOXIB [Celebrex]
 N Q Q Q Q
CELLCEPT
 N N N N N
CHANTIX
 N N N N N
COLCRYS
 N N N N N
COPAXONE
 N N N N QP
COZAAR
 N N N N N
CUBICIN
 N N N N N
DABIGATRAN ETEXILATE [Pradaxa]
Q N N Q Q
DAPTOMYCIN [Cubicin]
 N N N N N
DARIFENACIN [Enablex]
 N N N N Q
DEXTROSE
 P C C C C
DICLOFENAC EPOLAMINE [Flector]
 N N N N N
DICLOFENAC SOD ER [Voltaren-XR]
C C C C C
DONEPEZIL HYDROCHLORIDE
Q Q Q C 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 Medicare Rx Saver from UHC (PDP)
S5921-371		Cigna Healthcare Assurance Rx (PDP)
S5617-128		Humana Basic Rx Plan (PDP)
S5884-110		Wellcare Classic (PDP)
S4802-090		Humana Together in Health (PPO I-SNP)
H5216-444
EPINASTINE HCL [Elestat]
 N N N N N
 AARP Medicare Rx Saver from UHC (PDP)
S5921-371		Cigna Healthcare Assurance Rx (PDP)
S5617-128		Humana Basic Rx Plan (PDP)
S5884-110		Wellcare Classic (PDP)
S4802-090		Humana Together in Health (PPO I-SNP)
H5216-444
ESCITALOPRAM [LEXAPRO]
C Q Q C Q
ESOMEPRAZOLE [NEXIUM]
 N N N Q Q
ESZOPICLONE [LUNESTA]
 N N N N Q
EXELON
 N N N N N
EXELON PATCH
 N N N N N
Ezetimibe [Zetia]
Q Q Q C Q
Ezetimibe-Simvastatin [Vytorin]
 N Q Q N Q
FEBUXOSTAT [Uloric]
C SC S N N Q S
FENOFIBRIC ACID [TRILIPIX]
 N C N N N
FENTANYL PATCH
Q Q Q QP Q
FEXOFENADINE HCL
 N N N N N
FLECTOR PATCH
 N N N N N
FORTAZ
 N N N N N
FORTEO
 N QP QP N QP
FOSRENOL
 N N N N N
FRAGMIN
 N N N N N
GEODON
 N N N N N
GLATIRAMER [Copaxone]
 N N N N N
HUMALOG
C C N N C
Humalog PEN
C C N N C
HUMALOG KWIKPEN INJECTION
C C N N C
HUMALOG MIX 50/50
 N N N N N
HUMALOG MIX 75/25
C C N N C
HUMALOG MIX KWIKPEN INJECTION
C C N N C
IBANDRONATE SODIUM
Q Q Q Q Q
INSPRA
 N N N N N
INSULIN ASPART
 N N N C N
INSULIN ASPART [NovoLog PenFill]
 N N N C N
INSULIN ASPART PROT-INSULN [NovoLog Mix 70/30]
 N N N C N
INVEGA
C Q Q Q Q
IPRATROPIUM/ALBUTEROL
 N N N N N
IPRATROPIUM BROMIDE
 N N N N N
IPRATROPIUM BROMIDE NASAL
 N N N N N
IRBESARTAN [AVAPRO]
C Q Q Q 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 Medicare Rx Saver from UHC (PDP)
S5921-371		Cigna Healthcare Assurance Rx (PDP)
S5617-128		Humana Basic Rx Plan (PDP)
S5884-110		Wellcare Classic (PDP)
S4802-090		Humana Together in Health (PPO I-SNP)
H5216-444
LEVEMIR
 N N N N N
LEXAPRO
 N N N N N
LIDOCAINE DCL 1% VIAL
 N N N N N
LIDODERM PATCH
 N N N N N
LINEZOLID [Zyvox]
Q QP Q Q Q
LOTEMAX
 N N C N C
LOTEPREDNOL ETABONATE [LOTEMAX]
 N C N N N
LOVAZA
 N N N N N
LOVENOX
 N N N N N
LUBIPROSTONE [Amitiza]
Q Q Q N Q
LUMIGAN
 N C Q C Q
LUNESTA
 N N N N N
LUPRON DEPOT
QP P QP P QP
MEGACE ES
 N N N N N
MEGACE ORAL
 N N N N N
MELOXICAM
C C Q Q Q
Memantine HCl [Namenda]
QP QP QP P QP
Memantine HCl [Namenda Titration]
QP QP QP N QP
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 Q Q Q
NEUPOGEN
 N N N N N
NEXIUM
 N N N N N
NEXIUM IV
 N N N N N
NITRO-BID
C N N C N
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 Medicare Rx Saver from UHC (PDP)
S5921-371		Cigna Healthcare Assurance Rx (PDP)
S5617-128		Humana Basic Rx Plan (PDP)
S5884-110		Wellcare Classic (PDP)
S4802-090		Humana Together in Health (PPO I-SNP)
H5216-444
OLMESARTAN MEDOXOMIL [Benicar]
Q C Q Q Q
OMEGA-3 ETHYL ESTERS [Lovaza]
Q N Q N Q
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
QP P P C P
ONGLYZA
 N N N N N
Oseltamivir Phosphate [Tamiflu]
Q C Q Q Q
OXYCONTIN
 N N N N N
PALIPERIDONE (24 HR) ER [INVEGA]
 N N N N N
PANTOPRAZOLE [Protonix]
Q Q Q Q Q
PANTOPRAZOLE SODIUM
 N N N N N
PATADAY
 N N N N N
PIMECROLIMUS [Elidel]
Q SQP QP Q QP
PLAVIX
 N N N N N
PRADAXA
 N N N N N
PREVACID DELAYED RELEASE
 N N N N N
PREVACID SOLUTAB
 N N N N N
PRILOSEC
 N N N N N
PROCRIT
 P N N N N
PROGRAF
 P P P P P
PROLIA INJECTION
Q Q Q Q Q
PROMETHAZINE
C P C P C
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
Q N N N N
RAMELTEON [Rozerem]
Q N N N N
RANEXA
 N N N N N
RANOLAZINE [Ranexa]
Q Q Q C Q
 AARP Medicare Rx Saver from UHC (PDP)
S5921-371		Cigna Healthcare Assurance Rx (PDP)
S5617-128		Humana Basic Rx Plan (PDP)
S5884-110		Wellcare Classic (PDP)
S4802-090		Humana Together in Health (PPO I-SNP)
H5216-444
RECLAST INJECTION
 N N N N N
REGRANEX
 P P N Q N
REQUIP
 N N N N N
REVATIO
 N N N N N
RHINOCORT AQUA
 N N N N N
RISEDRONATE SODIUM [ACTONEL]
 N N N N Q
RISPERDAL CONSTA
 N Q Q Q Q
RISPERIDONE
C Q Q SQ Q S
ROZEREM
 N N N N N
SANCTURA
 N N N N N
SANCTURA XR
 N N N N N
SAXAGLIPTIN [ONGLYZA]
 N N Q N Q
SCOPOLAMINE TD [Transderm Scop]
C Q Q QP Q
SIMVASTATIN
Q Q C Q C
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
C P N C N
TOBRAMYCIN-DEXAMETH OPTH
C C C C C
TRANSDERM SCOP
 N N N N N
TRAVATAN Z
 N N N N N
TRAVOPROST [Travatan]
 N N N 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
C C C Q C
VOLTAREN
 N N N N N
 AARP Medicare Rx Saver from UHC (PDP)
S5921-371		Cigna Healthcare Assurance Rx (PDP)
S5617-128		Humana Basic Rx Plan (PDP)
S5884-110		Wellcare Classic (PDP)
S4802-090		Humana Together in Health (PPO I-SNP)
H5216-444
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
 P QP QP QP QP
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
Q Q C Q C
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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