168 HR estradiol 0.00188 MG/HR / levonorgestrel 0.000625 MG/HR Transdermal System [Climara Pro]
estradiol
RxCUI: 402252
What the CMS Formulary Data Shows for 168 HR estradiol 0.00188 MG/HR / levonorgestrel 0.000625 MG/HR Transdermal System [Climara Pro]
Per the CMS 2026 Part D formulary file, 168 HR estradiol 0.00188 MG/HR / levonorgestrel 0.000625 MG/HR Transdermal System [Climara Pro] (RxNorm concept RXCUI 402252, generic name estradiol) appears on 37 distinct formulary files spanning 1,058 Medicare Part D plan offerings - 20.9% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 3.8.
Real-world access to 168 HR estradiol 0.00188 MG/HR / levonorgestrel 0.000625 MG/HR Transdermal System [Climara Pro] depends on utilization management as much as tier placement: 8.1% of covering formularies require prior authorization. 0% require step therapy. 16.2% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 1,983 Part D beneficiaries filled 168 HR estradiol 0.00188 MG/HR / levonorgestrel 0.000625 MG/HR Transdermal System [Climara Pro] in 2023, with total plan-and-beneficiary spending of $3,615,168 and an average per-beneficiary annual cost of $1,823.08. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 168 HR estradiol 0.00188 MG/HR / levonorgestrel 0.000625 MG/HR Transdermal System [Climara Pro] today.
Coverage Details
- Formularies covering
- 37
- Plans covering
- 1,058
- Coverage rate
- 20.9%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 8.1% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 16.2% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,983
- Total spending
- $3,615,168
- Avg per beneficiary
- $1,823.08
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering 168 HR estradiol 0.00188 MG/HR / levonorgestrel 0.000625 MG/HR Transdermal System [Climara Pro]
5 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T4 | No | No | $0 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T4 | No | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T4 | No | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T4 | No | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T4 | No | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering 168 HR estradiol 0.00188 MG/HR / levonorgestrel 0.000625 MG/HR Transdermal System [Climara Pro]
95 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $0 | IN |
| Provider Partners Maryland Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $0 | MD |
| Provider Partners Missouri Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $0 | MO |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC. | T1 | No | $4.80 | TX |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS | T1 | No | $15.20 | IL |
| Provider Partners Maryland Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $31.20 | MD |
| Provider Partners Maryland Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $31.20 | MD |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $32.70 | PA |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $32.70 | PA |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $36.20 | NC |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $36.20 | NC |
| Provider Partners Indiana Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $38.40 | IN |
| Provider Partners Indiana Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $38.40 | IN |
| Provider Partners Kentucky Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF KENTUCKY | T1 | No | $38.40 | KY |
| Provider Partners Missouri Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $43.00 | MO |
| Provider Partners Missouri Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $43.00 | MO |
| CareAdvantage (HMO D-SNP) | SAN MATEO HEALTH COMMISSION | T2 | No | $0 | CA |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | No | $0 | CA |
| UHC Dual Complete IA-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | IA |
| UHC Dual Complete MO-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | MO |
| UHC Dual Complete NE-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | NE |
| UHC Dual Complete KS-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | KS |
| UHC Dual Complete MO-S3 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | MO |
| UHC Dual Complete KS-Q1 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | KS |
| UHC Dual Complete TN-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T4 | No | $0 | TN |
| UHC Dual Complete TN-Y001 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T4 | No | $0 | TN |
| UHC Dual Complete TN-Y2 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T4 | No | $0 | TN |
| AARP Medicare Advantage from UHC MI-0001 (PPO) | UNITEDHEALTHCARE INSURANCE COMPANY | T4 | No | $0 | MI |
| UHC Dual Complete NM-Y1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T4 | No | $0 | NM |
| UHC Dual Complete NM-S1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T4 | No | $0 | NM |
| UHC Dual Complete NM-V1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T4 | No | $0 | NM |
| UHC Dual Complete AZ-S001 (HMO-POS D-SNP) | ARIZONA PHYSICIANS IPA, INC. | T4 | No | $0 | AZ |
| UHC Dual Complete AZ-Y001 (HMO-POS D-SNP) | ARIZONA PHYSICIANS IPA, INC. | T4 | No | $0 | AZ |
| UHC Dual Complete VA-Y4 (PPO D-SNP) | CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO. | T4 | No | $0 | VA |
| AARP Medicare Advantage from UHC AL-0001 (HMO-POS) | UNITEDHEALTHCARE OF THE MIDLANDS, INC. | T4 | No | $0 | AL |
| AARP Medicare Advantage from UHC CA-0002 (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| UHC Sharp Medicare Advantage CA-001P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-003P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-0012 (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-004P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-005P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-006P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-10 (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-021P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-022P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-023P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-026P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
Frequently Asked Questions
Is 168 HR estradiol 0.00188 MG/HR / levonorgestrel 0.000625 MG/HR Transdermal System [Climara Pro] covered by Medicare Part D?
Yes, 168 HR estradiol 0.00188 MG/HR / levonorgestrel 0.000625 MG/HR Transdermal System [Climara Pro] is covered by 1,058 Medicare Part D plans (20.9% of all Part D formularies).
What tier is 168 HR estradiol 0.00188 MG/HR / levonorgestrel 0.000625 MG/HR Transdermal System [Climara Pro] on Medicare Part D plans?
168 HR estradiol 0.00188 MG/HR / levonorgestrel 0.000625 MG/HR Transdermal System [Climara Pro] averages Tier 3.8 across Part D plans, ranging from Tier 1 to Tier 4.
Does 168 HR estradiol 0.00188 MG/HR / levonorgestrel 0.000625 MG/HR Transdermal System [Climara Pro] require prior authorization?
8.1% of Part D formularies require prior authorization for 168 HR estradiol 0.00188 MG/HR / levonorgestrel 0.000625 MG/HR Transdermal System [Climara Pro]. Step therapy: 0%. Quantity limits: 16.2%.
How much does Medicare spend on 168 HR estradiol 0.00188 MG/HR / levonorgestrel 0.000625 MG/HR Transdermal System [Climara Pro]?
In 2023, total Medicare Part D spending on 168 HR estradiol 0.00188 MG/HR / levonorgestrel 0.000625 MG/HR Transdermal System [Climara Pro] was $3,615,168, covering 1,983 beneficiaries. The average spend per beneficiary was $1,823.08.
Read our methodology - how this data is sourced, computed, and verified.