FillMapDevoted Dual Full 013 Nc (HMO D-SNP)

Does Devoted Dual Full 013 Nc (HMO D-SNP) cover levothyroxine?

Devoted Dual Full 013 Nc (HMO D-SNP)
H5299-013-0 · MA_LOCAL · Medicare Part D
levothyroxine
Your Extra Help level

Everyone on this plan has Medicare and Medicaid, which qualifies you for Extra Help automatically — so the figures below already use the statutory copays, not this plan’s published cost sharing. Nothing here is saved.

Full Extra Help: no deductible, and at most $5.10 generic or $12.65 brand-name per fill.

Optional. Some plans charge less at a preferred pharmacy. Enter your ZIP to see which pharmacies near you take this plan — pick yours and the price above is re-worked for it. Until you do, we show what a standard pharmacy costs. Nothing here is saved.

levothyroxineunder Devoted Dual Full 013 Nc (HMO D-SNP)
Covered — just walk in
Nothing to clear first — take the prescription to an in-network pharmacy.
What you'd pay
25%of the price your plan negotiates

Medicare hasn’t published this plan’s negotiated price for this drug yet — that file is updated every three months, and newly launched drugs appear in it late. Your pharmacy can quote the exact amount today. Part D caps what you pay out of pocket at $2,100 for 2026. Before that, you pay the full price until you have paid $615 this year.

This plan charges the same at every pharmacy in its network — where you fill it will not change this figure.

Tier
Tier 1
Approval first
Not needed
Try another first
No
Amount limit
None
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 16, 2026 · CMS Part D monthly PUF. Reference information, not medical advice and not a price.

Covered forms and strengths (47)

  • levothyroxine sodium 0.025 MG Oral TabletTier 1
  • levothyroxine sodium 0.025 MG Oral Tablet [Levoxyl]Tier 1
  • levothyroxine sodium 0.025 MG Oral Tablet [Synthroid]Tier 2
  • levothyroxine sodium 0.025 MG Oral Tablet [Unithroid]Tier 1
  • levothyroxine sodium 0.05 MG Oral TabletTier 1
  • levothyroxine sodium 0.05 MG Oral Tablet [Levoxyl]Tier 1
  • levothyroxine sodium 0.05 MG Oral Tablet [Synthroid]Tier 2
  • levothyroxine sodium 0.05 MG Oral Tablet [Unithroid]Tier 1
  • levothyroxine sodium 0.075 MG Oral TabletTier 1
  • levothyroxine sodium 0.075 MG Oral Tablet [Levoxyl]Tier 1
  • levothyroxine sodium 0.075 MG Oral Tablet [Synthroid]Tier 2
  • levothyroxine sodium 0.075 MG Oral Tablet [Unithroid]Tier 1
  • levothyroxine sodium 0.088 MG Oral TabletTier 1
  • levothyroxine sodium 0.088 MG Oral Tablet [Levoxyl]Tier 1
  • levothyroxine sodium 0.088 MG Oral Tablet [Synthroid]Tier 2
  • levothyroxine sodium 0.088 MG Oral Tablet [Unithroid]Tier 1
  • levothyroxine sodium 0.1 MG Oral TabletTier 1
  • levothyroxine sodium 0.1 MG Oral Tablet [Levoxyl]Tier 1
  • levothyroxine sodium 0.1 MG Oral Tablet [Synthroid]Tier 2
  • levothyroxine sodium 0.1 MG Oral Tablet [Unithroid]Tier 1
  • levothyroxine sodium 0.112 MG Oral TabletTier 1
  • levothyroxine sodium 0.112 MG Oral Tablet [Levoxyl]Tier 1
  • levothyroxine sodium 0.112 MG Oral Tablet [Synthroid]Tier 2
  • levothyroxine sodium 0.112 MG Oral Tablet [Unithroid]Tier 1
  • levothyroxine sodium 0.125 MG Oral TabletTier 1
  • levothyroxine sodium 0.125 MG Oral Tablet [Levoxyl]Tier 1
  • levothyroxine sodium 0.125 MG Oral Tablet [Synthroid]Tier 2
  • levothyroxine sodium 0.125 MG Oral Tablet [Unithroid]Tier 1
  • levothyroxine sodium 0.137 MG Oral TabletTier 1
  • levothyroxine sodium 0.137 MG Oral Tablet [Levoxyl]Tier 1
  • levothyroxine sodium 0.137 MG Oral Tablet [Synthroid]Tier 2
  • levothyroxine sodium 0.137 MG Oral Tablet [Unithroid]Tier 1
  • levothyroxine sodium 0.15 MG Oral TabletTier 1
  • levothyroxine sodium 0.15 MG Oral Tablet [Levoxyl]Tier 1
  • levothyroxine sodium 0.15 MG Oral Tablet [Synthroid]Tier 2
  • levothyroxine sodium 0.15 MG Oral Tablet [Unithroid]Tier 1
  • levothyroxine sodium 0.175 MG Oral TabletTier 1
  • levothyroxine sodium 0.175 MG Oral Tablet [Levoxyl]Tier 1
  • levothyroxine sodium 0.175 MG Oral Tablet [Synthroid]Tier 2
  • levothyroxine sodium 0.175 MG Oral Tablet [Unithroid]Tier 1

← All coverage for levothyroxine