FillMapPremier HMO $5,500 - 40% Copay · 38166-38166WI0140036-0About this plan

Does Premier HMO $5,500 - 40% Copay cover levothyroxine?

1 · Your plan

Premier HMO $5,500 - 40% Copay

38166-38166WI0140036-0 · ACA · ACA Marketplace

2 · Your medication

levothyroxine

levothyroxineunder Premier HMO $5,500 - 40% Copay

Covered — just walk in

Nothing to clear first — take the prescription to an in-network pharmacy.

What you'd pay

45%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. 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.

Tier: Specialty drugs
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 14, 2026 · CMS QHP machine-readable. Reference information, not medical advice and not a price.

Your cost-sharing levelMarketplace plans publish a different amount for each level. Your eligibility notice says which applies. Nothing here is saved.

Covered forms and strengths (112)

levothyroxine sodium 0.013 MG Oral Capsule
levothyroxine sodium 0.013 MG Oral Capsule [Tirosint]
levothyroxine sodium 0.013 MG/ML Oral Solution [Tirosint]
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 [Synthroid]
levothyroxine sodium 0.025 MG Oral Tablet [Unithroid]
levothyroxine sodium 0.025 MG/ML Oral Solution [Tirosint]
levothyroxine sodium 0.0375 MG Oral Capsule [Tirosint]
levothyroxine sodium 0.0375 MG/ML Oral Solution [Tirosint]
levothyroxine sodium 0.044 MG Oral Capsule [Tirosint]
levothyroxine sodium 0.044 MG/ML Oral Solution [Tirosint]
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 [Synthroid]
levothyroxine sodium 0.05 MG Oral Tablet [Unithroid]
levothyroxine sodium 0.05 MG/ML Oral Solution [Tirosint]
levothyroxine sodium 0.0625 MG Oral Capsule [Tirosint]
levothyroxine sodium 0.0625 MG/ML Oral Solution [Tirosint]
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 [Synthroid]
levothyroxine sodium 0.075 MG Oral Tablet [Unithroid]
levothyroxine sodium 0.075 MG/ML Oral Solution [Tirosint]
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]

← All coverage for levothyroxine