FETZIMA 20 mg Capsule, Extended Release
Also known as Levomilnacipran Hydrochloride. Coverage in Delaware, DC and Maryland (CMS PDP Region 05).
10 of 10 stand-alone Part D plans in Delaware, DC and Maryland cover this drug on tier 3–4.
10 of 10 plans apply 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 |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 33% | — | $17.6441 | $52.933 units |
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| Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible | 4Non-Preferred Drug | 33% | — | $17.6441 | $52.933 units |
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| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $17.1053 | $51.323 units |
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| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible · $0 with full Extra Help | 3Preferred Brand | 25% | 25% | $17.1053 | $51.323 units |
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| HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $17.5570 | $52.673 units |
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| AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 36% | — | $18.9050 | $56.723 units |
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| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | 32% | $17.5655 | $52.703 units |
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| AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible | 4Non-Preferred Drug | 34% | — | $18.9050 | $56.723 units |
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| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $18.1289 | $108.776 units |
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| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $17.6441 | $52.933 units |
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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.
97 Medicare Advantage plans in DC, DE, MD do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. DC: 15 plans · DE: 32 plans · MD: 50 plans.