LYLLANA .0375 mg/d Patch, Extended Release
Also known as Estradiol. Coverage in Arizona (CMS PDP Region 28).
6 of 10 stand-alone Part D plans in Arizona cover this drug on tier 4.
6 of 6 plans apply a prior authorization, step therapy or quantity limit.
85 Medicare Advantage plans in AZ 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. AZ: 85 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 | 4Non-Preferred Drug | 32% | 32% | $8.3224 | $74.909 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $8.2866 | $74.589 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | — | $11.0652 | $99.599 units |
|
| Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $11.1445 | $100.309 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $4.5623 | $41.069 units |
|
| Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $11.0205 | $99.189 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.