{24 (drospirenone 3 MG / ethinyl estradiol 0.02 MG / levomefolate calcium 0.451 MG Oral Tablet) / 4 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Beyaz 28 Day]
drospirenone
RxCUI: 1013630
What the CMS Formulary Data Shows for {24 (drospirenone 3 MG / ethinyl estradiol 0.02 MG / levomefolate calcium 0.451 MG Oral Tablet) / 4 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Beyaz 28 Day]
Per the CMS 2026 Part D formulary file, {24 (drospirenone 3 MG / ethinyl estradiol 0.02 MG / levomefolate calcium 0.451 MG Oral Tablet) / 4 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Beyaz 28 Day] (RxNorm concept RXCUI 1013630, generic name drospirenone) appears on 1 distinct formulary file spanning 1 Medicare Part D plan offering - 0% 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 {24 (drospirenone 3 MG / ethinyl estradiol 0.02 MG / levomefolate calcium 0.451 MG Oral Tablet) / 4 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Beyaz 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 {24 (drospirenone 3 MG / ethinyl estradiol 0.02 MG / levomefolate calcium 0.451 MG Oral Tablet) / 4 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Beyaz 28 Day] today.
Coverage Details
- Formularies covering
- 1
- Plans covering
- 1
- Coverage rate
- 0%
- 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
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering {24 (drospirenone 3 MG / ethinyl estradiol 0.02 MG / levomefolate calcium 0.451 MG Oral Tablet) / 4 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Beyaz 28 Day]
1 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 |
Frequently Asked Questions
Is {24 (drospirenone 3 MG / ethinyl estradiol 0.02 MG / levomefolate calcium 0.451 MG Oral Tablet) / 4 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Beyaz 28 Day] covered by Medicare Part D?
Yes, {24 (drospirenone 3 MG / ethinyl estradiol 0.02 MG / levomefolate calcium 0.451 MG Oral Tablet) / 4 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Beyaz 28 Day] is covered by 1 Medicare Part D plans (0% of all Part D formularies).
What tier is {24 (drospirenone 3 MG / ethinyl estradiol 0.02 MG / levomefolate calcium 0.451 MG Oral Tablet) / 4 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Beyaz 28 Day] on Medicare Part D plans?
{24 (drospirenone 3 MG / ethinyl estradiol 0.02 MG / levomefolate calcium 0.451 MG Oral Tablet) / 4 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Beyaz 28 Day] averages Tier 2 across Part D plans, ranging from Tier 2 to Tier 2.
Does {24 (drospirenone 3 MG / ethinyl estradiol 0.02 MG / levomefolate calcium 0.451 MG Oral Tablet) / 4 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Beyaz 28 Day] require prior authorization?
0% of Part D formularies require prior authorization for {24 (drospirenone 3 MG / ethinyl estradiol 0.02 MG / levomefolate calcium 0.451 MG Oral Tablet) / 4 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Beyaz 28 Day]. Step therapy: 0%. Quantity limits: 0%.
Read our methodology - how this data is sourced, computed, and verified.