Drug Coverage Check · Plan Year 2026
Does this plan cover
Depo-SubQ Provera?
Verified · CMS 2026
YES — Covered
Depo-SubQ Provera is covered on Tier 4
30-day copay: $100.00 at a preferred pharmacy
Cost Details
30-Day Supply
- Preferred Pharmacy
- $100.00
- Standard Pharmacy
- $100.00
90-Day / Mail Order
- Preferred / Mail Order
- $0.00
- Standard Pharmacy
- $100.00
Deductible
- Applies to This Drug?
- Yes — deductible applies before copay
- Plan Deductible
- $250.00 / year
Lower-Cost Plans for Depo-SubQ Provera
These plans may offer a lower copay for Depo-SubQ Provera. Compare total annual costs including premium.
| # | Plan Name | Tier | 30-Day Copay | Monthly Premium | Rating | |
|---|---|---|---|---|---|---|
| 1 | Blue Shield Inspire (HMO) | Tier 3 | See Plan | $0.00/mo | — | View |
| 2 | Aetna Medicare Prime Extra (HMO) | Tier 3 | See Plan | $0.00/mo | — | View |
| 3 | Allina Health Aetna Medicare Signature Fit (PPO) | Tier 3 | See Plan | $0.00/mo | — | View |
| 4 | Tufts Medicare Preferred HMO Basic Rx (HMO) | Tier 3 | See Plan | $0.00/mo | — | View |
| 5 | Aetna Medicare Signature (PPO) | Tier 3 | See Plan | $0.00/mo | — | View |