FillMapDrPlus (HMO D-SNP)

Does DrPlus (HMO D-SNP) cover levothyroxine?

DrPlus (HMO D-SNP)
H4140-002-0 · 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 DrPlus (HMO D-SNP)
Covered — just walk in
Nothing to clear first — take the prescription to an in-network pharmacy.
What you'd pay
$0per 30-day fill

Part D caps what you pay out of pocket at $2,100 for 2026. From the first fill — no deductible on this drug.

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 (89)

  • levothyroxine sodium 0.013 MG Oral CapsuleTier 4
  • levothyroxine sodium 0.013 MG Oral Capsule [Tirosint]Tier 4
  • levothyroxine sodium 0.013 MG/ML Oral Solution [Tirosint]Tier 4
  • levothyroxine sodium 0.025 MG Oral CapsuleTier 4
  • levothyroxine sodium 0.025 MG Oral Capsule [Tirosint]Tier 4
  • levothyroxine sodium 0.025 MG Oral TabletTier 1
  • levothyroxine sodium 0.025 MG Oral Tablet [Levoxyl]Tier 3
  • levothyroxine sodium 0.025 MG Oral Tablet [Synthroid]Tier 3
  • levothyroxine sodium 0.025 MG Oral Tablet [Unithroid]Tier 4
  • levothyroxine sodium 0.025 MG/ML Oral Solution [Tirosint]Tier 4
  • levothyroxine sodium 0.0375 MG Oral Capsule [Tirosint]Tier 4
  • levothyroxine sodium 0.0375 MG/ML Oral Solution [Tirosint]Tier 4
  • levothyroxine sodium 0.044 MG Oral Capsule [Tirosint]Tier 4
  • levothyroxine sodium 0.044 MG/ML Oral Solution [Tirosint]Tier 4
  • levothyroxine sodium 0.05 MG Oral CapsuleTier 4
  • levothyroxine sodium 0.05 MG Oral Capsule [Tirosint]Tier 4
  • levothyroxine sodium 0.05 MG Oral TabletTier 1
  • levothyroxine sodium 0.05 MG Oral Tablet [Levoxyl]Tier 3
  • levothyroxine sodium 0.05 MG Oral Tablet [Synthroid]Tier 3
  • levothyroxine sodium 0.05 MG Oral Tablet [Unithroid]Tier 4
  • levothyroxine sodium 0.05 MG/ML Oral Solution [Tirosint]Tier 4
  • levothyroxine sodium 0.0625 MG Oral Capsule [Tirosint]Tier 4
  • levothyroxine sodium 0.0625 MG/ML Oral Solution [Tirosint]Tier 4
  • levothyroxine sodium 0.075 MG Oral CapsuleTier 4
  • levothyroxine sodium 0.075 MG Oral Capsule [Tirosint]Tier 4
  • levothyroxine sodium 0.075 MG Oral TabletTier 1
  • levothyroxine sodium 0.075 MG Oral Tablet [Levoxyl]Tier 3
  • levothyroxine sodium 0.075 MG Oral Tablet [Synthroid]Tier 3
  • levothyroxine sodium 0.075 MG Oral Tablet [Unithroid]Tier 4
  • levothyroxine sodium 0.075 MG/ML Oral Solution [Tirosint]Tier 4
  • levothyroxine sodium 0.088 MG Oral CapsuleTier 4
  • levothyroxine sodium 0.088 MG Oral Capsule [Tirosint]Tier 4
  • levothyroxine sodium 0.088 MG Oral TabletTier 1
  • levothyroxine sodium 0.088 MG Oral Tablet [Levoxyl]Tier 3
  • levothyroxine sodium 0.088 MG Oral Tablet [Synthroid]Tier 3
  • levothyroxine sodium 0.088 MG Oral Tablet [Unithroid]Tier 4
  • levothyroxine sodium 0.088 MG/ML Oral Solution [Tirosint]Tier 4
  • levothyroxine sodium 0.1 MG Oral CapsuleTier 4
  • levothyroxine sodium 0.1 MG Oral Capsule [Tirosint]Tier 4
  • levothyroxine sodium 0.1 MG Oral TabletTier 1

← All coverage for levothyroxine