168 HR estradiol 0.00417 MG/HR Transdermal System [Climara]

Verify with CMS →

estradiol

RxCUI: 310181

Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.
2.3%
Plan Coverage
115
Plans Covering
T2
Avg Tier
0%
Prior Auth Required

What the CMS Formulary Data Shows for 168 HR estradiol 0.00417 MG/HR Transdermal System [Climara]

Per the CMS 2026 Part D formulary file, 168 HR estradiol 0.00417 MG/HR Transdermal System [Climara] (RxNorm concept RXCUI 310181, generic name estradiol) appears on 2 distinct formulary files spanning 115 Medicare Part D plan offerings - 2.3% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 2 to Tier 2, with a cross-plan average of Tier 2.

Real-world access to 168 HR estradiol 0.00417 MG/HR Transdermal System [Climara] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.

Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 6,601 Part D beneficiaries filled 168 HR estradiol 0.00417 MG/HR Transdermal System [Climara] in 2023, with total plan-and-beneficiary spending of $3,683,131 and an average per-beneficiary annual cost of $557.97. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 168 HR estradiol 0.00417 MG/HR Transdermal System [Climara] today.

Coverage Details

Formularies covering
2
Plans covering
115
Coverage rate
2.3%
Tier range
Tier 2, Generic
Average tier
Tier 2, Generic

Restrictions

Prior authorization required
0% of formularies
Step therapy required
0% of formularies
Quantity limits
0% of formularies

2023 Medicare Spending

Beneficiaries
6,601
Total spending
$3,683,131
Avg per beneficiary
$557.97

Tier Distribution Across Plans

100 plans
Tier 2, Generic

Medicare Advantage Plans (MA-PD) Covering 168 HR estradiol 0.00417 MG/HR Transdermal System [Climara]

100 Medicare Advantage plans with Part D drug coverage include this drug.

Plan Insurer Tier PA Premium States
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Solano (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Inland Empire (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Ventura (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Kern (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Kern (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage San Diego (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Stanis (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Fresno (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Santa Cruz (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Alameda (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic SF (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Solano (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Advantage Inland Empire Value (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage San Diego Value (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Ventura Value (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Core DM (HMO) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Dual Essential (HMO D-SNP) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Silver DM (HMO-POS) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Core South (HMO) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Core North (HMO) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Bronze DM (HMO-POS) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Dual Complete (HMO D-SNP) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Senior Advantage Basic 1 (HMO) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Senior Advantage Basic 2 (HMO) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Dual Complete (HMO D-SNP) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Senior Advantage Basic (HMO) KAISER FOUNDATION HP, INC. T2 No $0 HI
Kaiser Permanente Medicare Advantage Value 1 VA (HMO-POS) KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES T2 No $0 VA
Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES T2 No $0 MD
Kaiser Permanente Dual Complete Plan 2 MD (HMO D-SNP) KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES T2 No $0 MD
Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP) KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES T2 No $0 MD
Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP) KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES T2 No $0 MD
Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES T2 No $0 DC
Kaiser Permanente Medicare Advantage Standard 2 MD (HMO-POS) KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES T2 No $0 MD
Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS) KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES T2 No $0 VA
Kaiser Permanente Medicare Advantage Value 1 MD (HMO) KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES T2 No $0 MD

Frequently Asked Questions

Is 168 HR estradiol 0.00417 MG/HR Transdermal System [Climara] covered by Medicare Part D?

Yes, 168 HR estradiol 0.00417 MG/HR Transdermal System [Climara] is covered by 115 Medicare Part D plans (2.3% of all Part D formularies).

What tier is 168 HR estradiol 0.00417 MG/HR Transdermal System [Climara] on Medicare Part D plans?

168 HR estradiol 0.00417 MG/HR Transdermal System [Climara] averages Tier 2 across Part D plans, ranging from Tier 2 to Tier 2.

Does 168 HR estradiol 0.00417 MG/HR Transdermal System [Climara] require prior authorization?

0% of Part D formularies require prior authorization for 168 HR estradiol 0.00417 MG/HR Transdermal System [Climara]. Step therapy: 0%. Quantity limits: 0%.

How much does Medicare spend on 168 HR estradiol 0.00417 MG/HR Transdermal System [Climara]?

In 2023, total Medicare Part D spending on 168 HR estradiol 0.00417 MG/HR Transdermal System [Climara] was $3,683,131, covering 6,601 beneficiaries. The average spend per beneficiary was $557.97.

Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare Editorial