FillMapModa Health Affinity Silver 3400

Does Moda Health Affinity Silver 3400 cover levothyroxine?

Moda Health Affinity Silver 3400
39424-39424OR1680002-0 · ACA · ACA Marketplace
levothyroxine
levothyroxineunder Moda Health Affinity Silver 3400
Covered — some forms require step therapy
17 of 102 covered forms have a condition attached. You may need to try a cheaper medication first — your doctor’s office handles it.
What you'd pay
$0per 30-day fill

From the first fill — no deductible on this drug.

This is the standard amount. If you qualified for a cost-sharing reduction when you enrolled, set your level above and this will follow it.

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
Not needed
Try another first
Required
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 (102)

  • levothyroxine sodium 0.013 MG Oral Capsule
  • levothyroxine sodium 0.013 MG Oral Capsule [Tirosint]
  • levothyroxine sodium 0.013 MG/ML Oral Solution [Tirosint]Try another first
  • levothyroxine sodium 0.02 MG/ML Oral Solution [Thyquidity]Try another first
  • levothyroxine sodium 0.025 MG Oral Capsule
  • levothyroxine sodium 0.025 MG Oral Capsule [Tirosint]
  • levothyroxine sodium 0.025 MG Oral Tablet
  • levothyroxine sodium 0.025 MG Oral Tablet [Euthyrox]
  • levothyroxine sodium 0.025 MG Oral Tablet [Levo-T]
  • levothyroxine sodium 0.025 MG Oral Tablet [Levoxyl]
  • levothyroxine sodium 0.025 MG Oral Tablet [Unithroid]
  • levothyroxine sodium 0.025 MG/ML Oral Solution [Tirosint]Try another first
  • levothyroxine sodium 0.03 MG/ML Oral Solution [Ermeza]Try another firstAmount limit
  • levothyroxine sodium 0.0375 MG Oral Capsule [Tirosint]
  • levothyroxine sodium 0.0375 MG/ML Oral Solution [Tirosint]Try another first
  • levothyroxine sodium 0.044 MG Oral Capsule [Tirosint]
  • levothyroxine sodium 0.044 MG/ML Oral Solution [Tirosint]Try another first
  • levothyroxine sodium 0.05 MG Oral Capsule
  • levothyroxine sodium 0.05 MG Oral Capsule [Tirosint]
  • levothyroxine sodium 0.05 MG Oral Tablet
  • levothyroxine sodium 0.05 MG Oral Tablet [Euthyrox]
  • levothyroxine sodium 0.05 MG Oral Tablet [Levo-T]
  • levothyroxine sodium 0.05 MG Oral Tablet [Levoxyl]
  • levothyroxine sodium 0.05 MG Oral Tablet [Unithroid]
  • levothyroxine sodium 0.05 MG/ML Oral Solution [Tirosint]Try another first
  • levothyroxine sodium 0.0625 MG Oral Capsule [Tirosint]
  • levothyroxine sodium 0.0625 MG/ML Oral Solution [Tirosint]Try another first
  • levothyroxine sodium 0.075 MG Oral Capsule
  • levothyroxine sodium 0.075 MG Oral Capsule [Tirosint]
  • levothyroxine sodium 0.075 MG Oral Tablet
  • levothyroxine sodium 0.075 MG Oral Tablet [Euthyrox]
  • levothyroxine sodium 0.075 MG Oral Tablet [Levo-T]
  • levothyroxine sodium 0.075 MG Oral Tablet [Levoxyl]
  • levothyroxine sodium 0.075 MG Oral Tablet [Unithroid]
  • levothyroxine sodium 0.075 MG/ML Oral Solution [Tirosint]Try another first
  • levothyroxine sodium 0.088 MG Oral Capsule
  • levothyroxine sodium 0.088 MG Oral Capsule [Tirosint]
  • levothyroxine sodium 0.088 MG Oral Tablet
  • levothyroxine sodium 0.088 MG Oral Tablet [Euthyrox]
  • levothyroxine sodium 0.088 MG Oral Tablet [Levo-T]

← All coverage for levothyroxine