Does 11574il0010055 cover estradiol?
11574il0010055
11574-11574IL0010055-0 · ACA · ACA Marketplace
estradiol
estradiolunder 11574il0010055
Covered — some forms require prior authorization
3 of 64 covered forms have a condition attached. Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
This plan doesn't publish a price for this tier. Your pharmacy can quote it before you fill.
Amount limit applies — you can still fill it, but your plan caps how much you get at a time. This plan's drug list records the cap without stating the amount — your pharmacy can tell you when they fill it.
- Tier
- Non preferred brand
- Approval first
- Required
- Try another first
- No
- Amount limit
- Yes
Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 14, 2026 · CMS QHP machine-readable. Reference information, not medical advice and not a price.
Covered forms and strengths (64)
- {18 (estradiol 0.004 MG Vaginal Insert [Imvexxy]) } Pack [Imvexxy 4 MCG Starter Pack]Amount limit
- {18 (estradiol 0.01 MG Vaginal Insert [Imvexxy]) } Pack [Imvexxy 10 MCG Starter Pack]Amount limit
- {8 (estradiol 0.004 MG Vaginal Insert [Imvexxy]) } Pack [Imvexxy 4 MCG Maintenance Pack]Amount limit
- {8 (estradiol 0.01 MG Vaginal Insert [Imvexxy]) } Pack [Imvexxy 10 MCG Maintenance Pack]Amount limit
- 1000 MG estradiol 0.001 MG/MG Topical Gel
- 1000 MG estradiol 0.001 MG/MG Topical Gel [Divigel]
- 1250 MG estradiol 0.001 MG/MG Topical Gel
- 1250 MG estradiol 0.001 MG/MG Topical Gel [Divigel]
- 168 HR estradiol 0.000583 MG/HR Transdermal System [Menostar]Approval first
- 168 HR estradiol 0.00104 MG/HR Transdermal SystemAmount limit
- 168 HR estradiol 0.00104 MG/HR Transdermal System [Climara]Amount limit
- 168 HR estradiol 0.00156 MG/HR Transdermal SystemAmount limit
- 168 HR estradiol 0.00156 MG/HR Transdermal System [Climara]Amount limit
- 168 HR estradiol 0.00208 MG/HR Transdermal SystemAmount limit
- 168 HR estradiol 0.00208 MG/HR Transdermal System [Climara]Amount limit
- 168 HR estradiol 0.0025 MG/HR Transdermal SystemAmount limit
- 168 HR estradiol 0.0025 MG/HR Transdermal System [Climara]Amount limit
- 168 HR estradiol 0.00312 MG/HR Transdermal SystemAmount limit
- 168 HR estradiol 0.00312 MG/HR Transdermal System [Climara]Amount limit
- 168 HR estradiol 0.00417 MG/HR Transdermal SystemAmount limit
- 168 HR estradiol 0.00417 MG/HR Transdermal System [Climara]Amount limit
- 250 MG estradiol 0.001 MG/MG Topical Gel
- 250 MG estradiol 0.001 MG/MG Topical Gel [Divigel]
- 500 MG estradiol 0.001 MG/MG Topical Gel
- 500 MG estradiol 0.001 MG/MG Topical Gel [Divigel]
- 750 MG estradiol 0.001 MG/MG Topical Gel
- 750 MG estradiol 0.001 MG/MG Topical Gel [Divigel]
- 84 HR estradiol 0.00104 MG/HR Transdermal SystemAmount limit
- 84 HR estradiol 0.00104 MG/HR Transdermal System [Alora]Amount limit
- 84 HR estradiol 0.00104 MG/HR Transdermal System [Minivelle]Amount limit
- 84 HR estradiol 0.00104 MG/HR Transdermal System [Vivelle]Amount limit
- 84 HR estradiol 0.00156 MG/HR Transdermal SystemAmount limit
- 84 HR estradiol 0.00156 MG/HR Transdermal System [Minivelle]Amount limit
- 84 HR estradiol 0.00156 MG/HR Transdermal System [Vivelle]Amount limit
- 84 HR estradiol 0.00208 MG/HR Transdermal SystemAmount limit
- 84 HR estradiol 0.00208 MG/HR Transdermal System [Minivelle]Amount limit
- 84 HR estradiol 0.00208 MG/HR Transdermal System [Vivelle]Amount limit
- 84 HR estradiol 0.00313 MG/HR Transdermal SystemAmount limit
- 84 HR estradiol 0.00313 MG/HR Transdermal System [Alora]Amount limit
- 84 HR estradiol 0.00313 MG/HR Transdermal System [Minivelle]Amount limit