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LEVOMILNACIPRAN HYDROCHLORIDE 120 mg/1 Medicare Part D Coverage

Brand name: Fetzima
Dosage form
CAPSULE, EXTENDED RELEASE
Route
ORAL
Drug class
SNRIs
100%
of Medicare Part D plans
cover LEVOMILNACIPRAN HYDROCHLORIDE
5,529 of 5,530 plans
3.8
Avg. formulary tier
$0.00
Median 30-day copay
$0.00–$0.00
Copay range

Formulary Tier Distribution

How Medicare Part D plans classify LEVOMILNACIPRAN HYDROCHLORIDE. Lower tiers = lower copays.

Tier 1 - Preferred Generic 3%
163 plans • avg $0.00/mo
Tier 2 - Generic 0%
5 plans • avg $0.00/mo
Tier 3 - Preferred Brand 11%
582 plans • avg $21.85/mo
Tier 4 - Non-Preferred Drug 86%
4,779 plans • avg $2.71/mo

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LEVOMILNACIPRAN HYDROCHLORIDE Medicare Coverage by State

Coverage rates and average costs vary significantly by state. Click a state to see the specific plans available there.

Alabama 100% Arizona 100% Arkansas 100% California 100% Colorado 100% Connecticut 100% Delaware 100% District of Columbia 100% Florida 100% Georgia 100% Hawaii 100% Idaho 100% Illinois 100% Indiana 100% Iowa 100% Kansas 100% Kentucky 100% Louisiana 100% Maine 100% Maryland 100% Massachusetts 100% Michigan 100% Minnesota 100% Mississippi 100% Missouri 100% Montana 100% Nebraska 100% Nevada 100% New Hampshire 100% New Jersey 100% New Mexico 100% New York 100% North Carolina 100% North Dakota 100% Ohio 100% Oklahoma 100% Oregon 100% Pennsylvania 100% Puerto Rico 100% Rhode Island 100% South Carolina 100% South Dakota 100% Tennessee 100% Texas 100% Utah 100% Vermont 100% Virginia 100% Washington 100% West Virginia 100% Wisconsin 100% Wyoming 100%

Alternative Medications in the Same Drug Class

Other drugs in the SNRIs that Medicare Part D plans also cover.

LEVOMILNACIPRAN HYDROCHLORIDE Avg Tier 3.8 $0.00/mo 5,529 plans Venlafaxine Hydrochloride Avg Tier 2.2 $13.00/mo 5,529 plans Venlafaxine Hydrochloride Avg Tier 2.3 $13.00/mo 5,529 plans LEVOMILNACIPRAN HYDROCHLORIDE Avg Tier 3.8 $0.00/mo 5,529 plans LEVOMILNACIPRAN HYDROCHLORIDE Avg Tier 3.8 $0.00/mo 5,529 plans Venlafaxine Hydrochloride Avg Tier 2.3 $13.00/mo 5,529 plans LEVOMILNACIPRAN HYDROCHLORIDE Avg Tier 3.8 $0.00/mo 5,529 plans Venlafaxine Hydrochloride Avg Tier 2.3 $13.00/mo 5,529 plans

Related Versions of LEVOMILNACIPRAN HYDROCHLORIDE

Fetzima 20 mg/1 Brand Fetzima Brand Fetzima 80 mg/1 Brand Fetzima 40 mg/1 Brand

Frequently Asked Questions about LEVOMILNACIPRAN HYDROCHLORIDE

100% of Medicare Part D plans cover LEVOMILNACIPRAN HYDROCHLORIDE. It is most commonly placed on Tier 4. Coverage varies by plan and geographic area.

The median 30-day copay for LEVOMILNACIPRAN HYDROCHLORIDE on Medicare Part D is $0.00 at a preferred pharmacy. Costs range from $0.00 to $0.00 depending on the plan.

LEVOMILNACIPRAN HYDROCHLORIDE is placed on Tier 4 by most Medicare Part D plans. Lower tier numbers generally mean lower copays.

0% of plans require prior authorization for LEVOMILNACIPRAN HYDROCHLORIDE. Prior authorization means your doctor must confirm the drug is medically necessary before the plan will cover it.

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Coverage statistics based on CMS formulary data for plan year 2026. Data updated regularly. Methodology →