DOTTI .0375 mg/d Patch, Extended Release
Also known as Estradiol. Coverage in Virginia (CMS PDP Region 07).
7 of 9 stand-alone Part D plans in Virginia cover this drug on tier 4.
7 of 7 plans apply a prior authorization, step therapy or quantity limit.
90 Medicare Advantage plans in VA 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. VA: 90 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 | 31% | 31% | $7.8078 | $70.279 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $7.8078 | $70.279 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | — | $9.2906 | $83.629 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 4Non-Preferred Drug | 32% | — | $9.4823 | $85.349 units |
|
| SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $5.0141 | $45.139 units |
|
| Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $9.1827 | $82.649 units |
|
| HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $8.3077 | $74.779 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.