Modified

500 MG — Extended Release Tablet

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

Medicare Part D

18 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 19 hours, 7 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Aetna Medicare Signature (HMO)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL
Aetna Medicare Dual (HMO D-SNP)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL
Aetna Medicare Signature (HMO)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL
Aetna Medicare Value Plus (HMO)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL
Aetna Medicare Prime (HMO)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL
Aetna Medicare Signature Care (HMO)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL
Aetna Medicare Full Dual Care (HMO D-SNP)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL
Aetna Medicare Enhanced (HMO)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL
Aetna Medicare Enhanced (PPO)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL
Aetna Medicare Enhanced (PPO)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL
Aetna Medicare Signature Extra (PPO)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL
Aetna Medicare Signature Giveback (PPO)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL
Aetna Medicare Chronic Care (HMO C-SNP)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL
Aetna Medicare Chronic Care Value (HMO C-SNP)	Tier 4 - Non-Preferred	✓	—	✓ 120 per 30 days	PA \| QL