MIRENA 52 mg Intrauterine Device
Also known as Levonorgestrel. Coverage in Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming (CMS PDP Region 25).
3 of 11 stand-alone Part D plans in Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming cover this drug on tier 3.
Lowest 30-day cost $45.00 at a preferred pharmacy. No plan applies a prior authorization, step therapy or quantity limit.
Every plan that covers it
Showing 3 of 3 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$4.70/mo premium · $615.00 deductible · $0 with full Extra Help | 3Preferred Brand | 25% | 20% | $1225.7839 | — | None |
| Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1225.7839 | — | None |
| Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1225.7839 | — | 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.
48 Medicare Advantage plans in IA, MN, MT, NE, WY do cover it
A patient on an MA-PD plan may have coverage even where no PDP lists the drug. IA: 8 plans · MN: 17 plans · MT: 15 plans · NE: 6 plans · WY: 2 plans.