LUPRON DEPOT Kit

Also known as Leuprolide Acetate. Coverage in Alaska (CMS PDP Region 34).

3 of 9 stand-alone Part D plans in Alaska cover this drug on tier 4–5.

3 of 3 plans apply a prior authorization, step therapy or quantity limit.

Every plan that covers it

Plan	Tier	30-day preferred	90-day mail	Unit cost	Est. 30-day fill	Restrictions
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible	4Non-Preferred Drug	29%	29%	$8591.3518	—	Prior authorization
AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$9378.6427	$2,532.230.27 units	Prior authorization Quantity limit 1 per 112 days
AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible	5Specialty Tier	31%	—	$9378.6427	$2,532.230.27 units	Prior authorization Quantity limit 1 per 112 days

Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity.

See coverage in all 39 regions →