LEVOTHYROXINE SODIUM 100 ug Tablet
Coverage in Wisconsin (CMS PDP Region 16).
10 of 10 stand-alone Part D plans in Wisconsin cover this drug on tier 1–2.
Lowest 30-day cost $0.00 at a preferred pharmacy. No plan applies a prior authorization, step therapy or quantity limit.
Every plan that covers it
Showing 10 of 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 1Preferred Generic | $0.00 | $0.00 | $0.0597 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 1Preferred Generic | $0.00 | $0.00 | $0.1759 | — | None |
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help | 1Preferred Generic | $0.00 | $0.00 | $0.1814 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 1Preferred Generic | $2.00 | $6.00 | $0.1661 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 2Generic | $10.00 | $30.00 | $0.2221 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 2Generic | 10% | 10% | $0.0877 | — | None |
| SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.0852 | — | None |
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2764 | — | None |
| Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1759 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.2399 | — | None |
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.
Medicare Advantage plans
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D, and are sold county by county. Pick a county to see every Medicare Advantage drug plan there that covers this drug.
88 Medicare Advantage plans in WI do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. WI: 88 plans.