LYLLANA .075 mg/d Patch, Extended Release
Also known as Estradiol. Coverage in Hawaii (CMS PDP Region 33).
6 of 8 stand-alone Part D plans in Hawaii cover this drug on tier 4.
6 of 6 plans apply a prior authorization, step therapy or quantity limit.
26 Medicare Advantage plans in HI 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. HI: 26 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)$0.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | — | $8.8586 | $79.739 units |
|
| SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $11.6695 | $105.039 units |
|
| Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $11.0364 | $99.339 units |
|
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $10.7799 | $97.029 units |
|
| Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible | 4Non-Preferred Drug | 30% | — | $8.8791 | $79.919 units |
|
| Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $8.8470 | $79.629 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.