LYLLANA .025 mg/d Patch, Extended Release
Also known as Estradiol. Coverage in California (CMS PDP Region 32).
8 of 12 stand-alone Part D plans in California cover this drug on tier 4.
8 of 8 plans apply a prior authorization, step therapy or quantity limit.
210 Medicare Advantage plans in CA 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. CA: 210 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $8.6880 | $78.199 units |
|
| Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $8.6880 | $78.199 units |
|
| SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $3.5288 | $31.769 units |
|
| Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible | 4Non-Preferred Drug | 32% | — | $9.7881 | $88.099 units |
|
| Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | — | $9.7281 | $87.559 units |
|
| Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $9.6944 | $87.259 units |
|
| Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 49% | 49% | $14.5867 | $247.9717 units |
|
| Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible | 4Non-Preferred Drug | 37% | 37% | $14.5867 | $247.9717 units |
|
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.