{21 (drospirenone 3 MG / ethinyl estradiol 0.03 MG / levomefolate calcium 0.451 MG Oral Tablet) / 7 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Safyral 28 Day]

Verify with CMS →

drospirenone

RxCUI: 1050494

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.
0.3%
Plan Coverage
16
Plans Covering
T3.3
Avg Tier
0%
Prior Auth Required

What the CMS Formulary Data Shows for {21 (drospirenone 3 MG / ethinyl estradiol 0.03 MG / levomefolate calcium 0.451 MG Oral Tablet) / 7 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Safyral 28 Day]

Per the CMS 2026 Part D formulary file, {21 (drospirenone 3 MG / ethinyl estradiol 0.03 MG / levomefolate calcium 0.451 MG Oral Tablet) / 7 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Safyral 28 Day] (RxNorm concept RXCUI 1050494, generic name drospirenone) appears on 3 distinct formulary files spanning 16 Medicare Part D plan offerings - 0.3% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 2 to Tier 4, with a cross-plan average of Tier 3.3.

Real-world access to {21 (drospirenone 3 MG / ethinyl estradiol 0.03 MG / levomefolate calcium 0.451 MG Oral Tablet) / 7 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Safyral 28 Day] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.

Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry {21 (drospirenone 3 MG / ethinyl estradiol 0.03 MG / levomefolate calcium 0.451 MG Oral Tablet) / 7 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Safyral 28 Day] today.

Coverage Details

Formularies covering
3
Plans covering
16
Coverage rate
0.3%
Tier range
Tier 2 – Tier 4
Average tier
Tier 3, Preferred Brand

Restrictions

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

Tier Distribution Across Plans

1 plans
Tier 2, Generic
15 plans
Tier 4, Non-Preferred

Medicare Advantage Plans (MA-PD) Covering {21 (drospirenone 3 MG / ethinyl estradiol 0.03 MG / levomefolate calcium 0.451 MG Oral Tablet) / 7 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Safyral 28 Day]

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

Plan Insurer Tier PA Premium States
CalOptima Health OneCare Complete (HMO D-SNP) ORANGE COUNTY HEALTH AUTHORITY T2 No $0 CA
Select Health Medicare Essential (HMO) SELECTHEALTH, INC. T4 No $0 UT
Select Health Medicare Essential (HMO) SELECTHEALTH, INC. T4 No $0 NV
Select Health Medicare Dual (HMO D-SNP) SELECTHEALTH, INC. T4 No $0 UT
Select Health Medicare Essential (HMO) SELECTHEALTH, INC. T4 No $0 UT
Select Health Medicare + Kroger (HMO) SELECTHEALTH, INC. T4 No $0 NV
Select Health Medicare + Kroger (HMO) SELECTHEALTH, INC. T4 No $0 UT
Select Health Medicare Essential (HMO) SELECTHEALTH, INC. T4 No $0 CO
Select Health Medicare Essential (HMO) SELECTHEALTH, INC. T4 No $0 CO
Select Health Medicare + Kroger (HMO) SELECTHEALTH, INC. T4 No $0 CO
Select Health Medicare Flex (HMO) SELECTHEALTH, INC. T4 No $0 CO
Select Health Medicare + Kroger (HMO) SELECTHEALTH, INC. T4 No $0 CO
Select Health Medicare Active (HMO) SELECTHEALTH, INC. T4 No $0 CO
Select Health Medicare Dual (HMO D-SNP) SELECTHEALTH, INC. T4 No $0 NV
Select Health Medicare Wellness (HMO) SELECTHEALTH, INC. T4 No $0 NV
Healthy Mississippi Premier Advantage (HMO-POS) Healthy Mississippi, Inc. T4 No $0 MS

Frequently Asked Questions

Is {21 (drospirenone 3 MG / ethinyl estradiol 0.03 MG / levomefolate calcium 0.451 MG Oral Tablet) / 7 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Safyral 28 Day] covered by Medicare Part D?

Yes, {21 (drospirenone 3 MG / ethinyl estradiol 0.03 MG / levomefolate calcium 0.451 MG Oral Tablet) / 7 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Safyral 28 Day] is covered by 16 Medicare Part D plans (0.3% of all Part D formularies).

What tier is {21 (drospirenone 3 MG / ethinyl estradiol 0.03 MG / levomefolate calcium 0.451 MG Oral Tablet) / 7 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Safyral 28 Day] on Medicare Part D plans?

{21 (drospirenone 3 MG / ethinyl estradiol 0.03 MG / levomefolate calcium 0.451 MG Oral Tablet) / 7 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Safyral 28 Day] averages Tier 3.3 across Part D plans, ranging from Tier 2 to Tier 4.

Does {21 (drospirenone 3 MG / ethinyl estradiol 0.03 MG / levomefolate calcium 0.451 MG Oral Tablet) / 7 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Safyral 28 Day] require prior authorization?

0% of Part D formularies require prior authorization for {21 (drospirenone 3 MG / ethinyl estradiol 0.03 MG / levomefolate calcium 0.451 MG Oral Tablet) / 7 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Safyral 28 Day]. Step therapy: 0%. Quantity limits: 0%.

Read our methodology - how this data is sourced, computed, and verified.

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