LYLLANA .0375 mg/d Patch, Extended Release
Also known as Estradiol. Coverage in Idaho and Utah (CMS PDP Region 31).
6 of 10 stand-alone Part D plans in Idaho and Utah cover this drug on tier 4.
6 of 6 plans apply a prior authorization, step therapy or quantity limit.
57 Medicare Advantage plans in ID, UT 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. ID: 25 plans · UT: 32 plans.
Every plan that covers it
| 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 | 4Non-Preferred Drug | 33% | — | $9.3372 | $84.039 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $9.7764 | $87.999 units |
|
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 4Non-Preferred Drug | 32% | — | $9.3660 | $84.299 units |
|
| Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $9.8858 | $88.979 units |
|
| SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $4.6849 | $42.169 units |
|
| Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $9.3210 | $83.899 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.