Drospirenone / estradiol (Angeliq)

How Medicare covers it

Part D (forms used at home). Part A during a covered inpatient stay. No Part B clinician-administered form in the CMS Part B spending file.

What it treats

Menopause hormone therapy: moderate to severe hot flashes (vasomotor symptoms) due to menopause, and moderate to severe vulvar and vaginal atrophy due to menopause, in women with a uterus.

What it is for, in depth

Angeliq combines estradiol with drospirenone, a progestogen related to the diuretic spironolactone, in one daily tablet for women who still have a uterus and need endometrial protection from estrogen. The drospirenone component tends to reduce the bloating and blood-pressure rise some women get on other progestins, but it also means potassium must be watched and the drug avoided in kidney, liver, or adrenal disease. Hormone therapy decisions weigh symptom relief against the clotting, stroke, and breast-cancer risks quantified in the Women's Health Initiative studies.

How it works

Estradiol replaces the estrogen that falls at menopause, easing hot flashes and vaginal changes. Drospirenone is a progestogen that protects the uterine lining from estrogen-driven overgrowth; it also has a mild water-pill effect that counteracts fluid retention and can raise potassium.

How it is taken

One tablet by mouth once a day, continuously, without a hormone-free break.

Common side effects

['Breast pain or tenderness', 'Headache', 'Breakthrough bleeding or spotting', 'Nausea', 'Mood changes']

Serious warnings

['Blood clots, stroke, and heart attack risks of estrogen therapy (see boxed warning)', 'High potassium, especially with kidney or adrenal problems; the drug must not be used in renal impairment, adrenal insufficiency, or liver disease', 'Gallbladder disease and large rises in triglycerides or calcium, which require stopping estrogen']

Boxed warning

Estrogen warnings from the Women's Health Initiative and class labeling: estrogens increase the risk of endometrial cancer when used without a progestogen in women with a uterus; WHI studies found increased risks of stroke, deep vein thrombosis, pulmonary embolism, myocardial infarction, invasive breast cancer, and probable dementia in women 65 and older. Estrogen therapy should be used at the lowest effective dose for the shortest duration consistent with treatment goals.

Who should be careful

['Anyone with a history of blood clots, stroke, heart attack, or breast cancer (all contraindications)', 'People with kidney impairment, adrenal insufficiency, or liver disease (contraindications)', 'People with undiagnosed abnormal genital bleeding', 'Women 65 and older, in whom dementia risk was increased in studies']

Major interactions

['Drugs and supplements that raise potassium, including ACE inhibitors, ARBs, spironolactone, and potassium supplements', 'Strong CYP3A4 inhibitors, which raise hormone levels', 'Thyroid hormone replacement, whose dose may need adjustment as estrogen changes binding proteins']

Cost and saving notes

Angeliq is a brand product without a US generic equivalent, so Part D plans that list it usually place it on a non-preferred tier; many plans instead prefer generic estradiol plus a separate generic progestin. Ask your prescriber whether separate generic components are an acceptable substitute, or request a tier exception. Extra Help can reduce costs if you qualify. The 2027 Part D out-of-pocket cap is $2,400 for the year, and the Medicare Prescription Payment Plan can spread that cost across the year.

Why it is in its tier

Drospirenone / estradiol (Angeliq) sits on Tier 4 in 96.55% of the plans that list it (28 of 29 listing plans). Tier 4 is the non-preferred tier — higher copays or coinsurance. The data-visible drivers: It is a generic product, and the CMS dashboard puts its average Part D spending at about $1,351 per beneficiary for 2024 — a mid-cost drug, which matches where plans place it. Only 0.53% of Part D plans list it at all, so many readers will find their plan does not list it and covers a similar drug instead. The tier shown is the most common one; individual plans vary.

Sources

• ANGELIQ (DROSPIRENONE AND ESTRADIOL) TABLET, FILM COATED [BAYER HEALTHCARE PHARMACEUTICALS INC.] — DailyMed

Part D formulary coverage

Source: CMS Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files — Monthly file 2026-10-15 (plan year 2027), file 2027_20261008.zip (data.cms.gov dataset ed1496ea-23e7-41f1-9292-172fa842ccfb): basic drugs formulary file + plan information file, both dated 20261031 inside the zip; downloaded and aggregated 2026-10-30. Medication RxCUI sets resolved through the NLM RxNav (RxNorm) API.

What you pay

Without insurance, the cash benchmark is 6.36125 per unit (ANGELIQ 0.25 MG-0.5 MG TABLET) — about nan for 30 units. NADAC benchmark — the average price pharmacies pay (CMS, as of 2026-11-04). Pharmacy shelf prices vary.

A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.

Sources: CMS Plan Benefit Package + formulary data; CMS NADAC · Checked 2026-11-07

Coverage by plan and tier

Of the 5,495 Medicare drug plans we track for 2027, 29 list Drospirenone / estradiol (Angeliq) — 0.5% of plans. Most of those plans put it on Tier 4: 28 plans, 96.5% of the plans that list it. Other plans place it on Tier 1 (1 plans). For example: CalOptima Health OneCare Complete (HMO D-SNP) puts it on Tier 1; Univera SeniorChoice Secure (HMO-POS) puts it on Tier 4; Medicare Blue Choice Optimum (HMO-POS) puts it on Tier 4. You can compare these plans side by side on our Medicare Advantage hub. A tier is not a price. What you pay also depends on whether you have met your plan';s deductible, whether the drug costs a flat copay or a share of the price, and whether you get Extra Help or Medicaid.

Read next

• Part D in 2027: The $700 Deductible, the $2,400 Cap, and the $35 Insulin Rule
• Extra Help in 2027: Lower Drug Copays and Who Qualifies
• Checking Medicare Savings Programs and Extra Help

Part D spending averages (2024)

Source: CMS Medicare Part D Spending by Drug (Drug Spending Dashboard), release RY26 P04 V10, data through 2024 (DSD_PTD_RY26_P04_V10_DY24_BGM.csv), downloaded 2026-10-30

Companies covering this drug

Part D and Medicare Advantage plan sponsors that list this drug on a formulary, 50 at a time.