LYLLANA .05 mg/d Patch, Extended Release
Also known as Estradiol. Coverage in Oklahoma (CMS PDP Region 23).
7 of 11 stand-alone Part D plans in Oklahoma cover this drug on tier 3–4.
5 of 7 plans apply a prior authorization, step therapy or quantity limit.
44 Medicare Advantage plans in OK 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. OK: 44 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $5.9546 | — | None |
| Blue Cross MedicareRx Basic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $5.2090 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | — | $9.4924 | $85.439 units |
|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $6.4513 | $58.069 units |
|
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 26% | 26% | $6.4577 | $58.129 units |
|
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 4Non-Preferred Drug | 35% | — | $10.0949 | $90.859 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $9.1535 | $82.389 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.