0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Vabrinty]

Verify with CMS →

leuprolide acetate

RxCUI: 2720348

Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.
2.8%
Plan Coverage
143
Plans Covering
T4.6
Avg Tier
57.1%
Prior Auth Required

What the CMS Formulary Data Shows for 0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Vabrinty]

Per the CMS 2026 Part D formulary file, 0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Vabrinty] (RxNorm concept RXCUI 2720348, generic name leuprolide acetate) appears on 7 distinct formulary files spanning 143 Medicare Part D plan offerings - 2.8% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 3 to Tier 5, with a cross-plan average of Tier 4.6.

Real-world access to 0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Vabrinty] depends on utilization management as much as tier placement: 57.1% of covering formularies require prior authorization. 0% require step therapy. 14.3% apply quantity limits.

Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Vabrinty] today.

Coverage Details

Formularies covering
7
Plans covering
143
Coverage rate
2.8%
Tier range
Tier 3 – Tier 5
Average tier
Tier 5, Specialty

Restrictions

Prior authorization required
57.1% of formularies
Step therapy required
0% of formularies
Quantity limits
14.3% of formularies

Tier Distribution Across Plans

4 plans
Tier 3, Preferred Brand
4 plans
Tier 4, Non-Preferred
92 plans
Tier 5, Specialty

Medicare Advantage Plans (MA-PD) Covering 0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Vabrinty]

100 Medicare Advantage plans with Part D drug coverage include this drug.

Plan Insurer Tier PA Premium States
Leon MediExtra (HMO) LEON HEALTH, INC. T3 Yes $0 FL
Leon MediDual (HMO D-SNP) LEON HEALTH, INC. T3 Yes $0 FL
Leon MediMore (HMO) LEON HEALTH, INC. T3 Yes $0 FL
Leon MediMax (HMO D-SNP) LEON HEALTH, INC. T3 Yes $0 FL
Aspire Health Protect (HMO) ASPIRE HEALTH PLAN T4 Yes $0 CA
Aspire Health Value (HMO) ASPIRE HEALTH PLAN T4 Yes $22.60 CA
Aspire Health Advantage (HMO) ASPIRE HEALTH PLAN T4 Yes $44.80 CA
Aspire Health Plus (HMO-POS) ASPIRE HEALTH PLAN T4 Yes $119.20 CA
HAP Medicare Explore (PPO) ALLIANCE HEALTH AND LIFE INSURANCE COMPANY T5 Yes $0 MI
HAP Medicare Prime (PPO) ALLIANCE HEALTH AND LIFE INSURANCE COMPANY T5 Yes $0 MI
HAP Medicare Connect (HMO) HEALTH ALLIANCE PLAN OF MICHIGAN T5 Yes $0 MI
HAP Medicare Complete Duals (HMO D-SNP) HEALTH ALLIANCE PLAN OF MICHIGAN T5 Yes $0 MI
HAP Medicare Superior (HMO) HEALTH ALLIANCE PLAN OF MICHIGAN T5 Yes $0 MI
Henry Ford Select (HMO) HEALTH ALLIANCE PLAN OF MICHIGAN T5 Yes $0 MI
Health New England Medicare Compass (PPO) HEALTH NEW ENGLAND, INC. T5 Yes $0 MA
Health New England Medicare Value (HMO) HEALTH NEW ENGLAND, INC. T5 Yes $0 MA
Presbyterian Senior Care Plan 2 with Rx (HMO) PRESBYTERIAN HEALTH PLAN T5 No $0 NM
Presbyterian Dual Plus (HMO D-SNP) PRESBYTERIAN HEALTH PLAN T5 No $0 NM
Presbyterian Senior Care Extra Health Plan with Rx (HMO) PRESBYTERIAN HEALTH PLAN T5 No $0 NM
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Solano (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Inland Empire (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Ventura (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Kern (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic Kern (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage San Diego (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic Stanis (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic Fresno (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Santa Cruz (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic Alameda (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic SF (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic Solano (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Sr Advantage Inland Empire Value (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage San Diego Value (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Ventura Value (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Core DM (HMO) KAISER FOUNDATION HP OF CO T5 No $0 CO
Kaiser Permanente Dual Essential (HMO D-SNP) KAISER FOUNDATION HP OF CO T5 No $0 CO
Kaiser Permanente Senior Advantage Silver DM (HMO-POS) KAISER FOUNDATION HP OF CO T5 No $0 CO
Kaiser Permanente Senior Advantage Core South (HMO) KAISER FOUNDATION HP OF CO T5 No $0 CO
Kaiser Permanente Senior Advantage Core North (HMO) KAISER FOUNDATION HP OF CO T5 No $0 CO
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) KAISER FOUNDATION HP OF CO T5 No $0 CO

Frequently Asked Questions

Is 0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Vabrinty] covered by Medicare Part D?

Yes, 0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Vabrinty] is covered by 143 Medicare Part D plans (2.8% of all Part D formularies).

What tier is 0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Vabrinty] on Medicare Part D plans?

0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Vabrinty] averages Tier 4.6 across Part D plans, ranging from Tier 3 to Tier 5.

Does 0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Vabrinty] require prior authorization?

57.1% of Part D formularies require prior authorization for 0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Vabrinty]. Step therapy: 0%. Quantity limits: 14.3%.

Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare Editorial