DOTTI .025 mg/d Patch, Extended Release
Also known as Estradiol. Coverage in Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming (CMS PDP Region 25).
9 of 11 stand-alone Part D plans in Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming cover this drug on tier 4.
8 of 9 plans apply a prior authorization, step therapy or quantity limit.
191 Medicare Advantage plans in IA, MN, MT, NE, ND, SD, WY 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. IA: 44 plans · MN: 56 plans · MT: 20 plans · NE: 37 plans · ND: 15 plans · SD: 17 plans · WY: 2 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)$4.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 34% | — | $8.5058 | $76.559 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $9.5243 | $85.729 units |
|
| Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $9.5246 | $85.729 units |
|
| Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $8.6992 | $78.299 units |
|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $5.6288 | $50.669 units |
|
| HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $7.5552 | $68.009 units |
|
| MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 42% | 42% | $8.2103 | — | None |
| Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $8.3969 | $75.579 units |
|
| HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $7.7801 | $70.029 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.