NORELGESTROMIN AND ETHINYL ESTRADIOL 150/35 ug/mg Patch
Coverage in Texas (CMS PDP Region 22).
10 of 12 stand-alone Part D plans in Texas cover this drug on tier 3.
Lowest 30-day cost $45.00 at a preferred pharmacy. 3 of 10 plans apply a prior authorization, step therapy or quantity limit.
361 Medicare Advantage plans in TX 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. TX: 361 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 | 3Preferred Brand | 25% | 25% | $24.6867 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $24.6867 | — | None |
| Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $50.1677 | $150.503 units |
|
| Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $49.0425 | $147.133 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$89.20/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $32.0174 | — | None |
| SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $21.0212 | — | None |
| Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $37.1445 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $31.4979 | — | None |
| Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $48.4095 | $145.233 units |
|
| Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $37.1153 | — | None |
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.