XULANE 150/35 ug/d Patch
Also known as Norelgestromin And Ethinyl Estradiol. Coverage in Michigan (CMS PDP Region 13).
10 of 12 stand-alone Part D plans in Michigan cover this drug on tier 3.
Lowest 30-day cost $45.00 at a preferred pharmacy. 3 of 10 plans apply a prior authorization, step therapy or quantity limit.
177 Medicare Advantage plans in MI do cover it
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D. A patient on an MA-PD plan may have coverage even where no PDP lists the drug. MI: 177 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $22.6344 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $22.6344 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $55.4433 | $166.333 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $55.8038 | $167.413 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $31.0446 | — | None |
| SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $26.1663 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $30.8862 | — | None |
| Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $34.4002 | — | None |
| Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $55.2405 | $165.723 units |
|
| Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible | 3Preferred Brand | 24% | 24% | $34.4002 | — | 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.