LYLLANA .075 mg/d Patch, Extended Release
Also known as Estradiol. Coverage in Mississippi (CMS PDP Region 20).
6 of 10 stand-alone Part D plans in Mississippi cover this drug on tier 4.
6 of 6 plans apply a prior authorization, step therapy or quantity limit.
62 Medicare Advantage plans in MS 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. MS: 62 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 | 29% | 29% | $8.0158 | $72.149 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $8.0158 | $72.149 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | — | $10.2601 | $92.349 units |
|
| Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible | 4Non-Preferred Drug | 35% | — | $10.5023 | $94.529 units |
|
| Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $10.1238 | $91.119 units |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $4.5814 | $41.239 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.