1 ML medroxyprogesterone acetate 150 MG/ML Prefilled Syringe [Depo-Provera]
medroxyprogesterone acetate
RxCUI: 1000154
What the CMS Formulary Data Shows for 1 ML medroxyprogesterone acetate 150 MG/ML Prefilled Syringe [Depo-Provera]
Per the CMS 2026 Part D formulary file, 1 ML medroxyprogesterone acetate 150 MG/ML Prefilled Syringe [Depo-Provera] (RxNorm concept RXCUI 1000154, generic name medroxyprogesterone acetate) appears on 13 distinct formulary files spanning 27 Medicare Part D plan offerings - 0.5% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.6.
Real-world access to 1 ML medroxyprogesterone acetate 150 MG/ML Prefilled Syringe [Depo-Provera] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 61 Part D beneficiaries filled 1 ML medroxyprogesterone acetate 150 MG/ML Prefilled Syringe [Depo-Provera] in 2023, with total plan-and-beneficiary spending of $9,826 and an average per-beneficiary annual cost of $161.08. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 1 ML medroxyprogesterone acetate 150 MG/ML Prefilled Syringe [Depo-Provera] today.
Coverage Details
- Formularies covering
- 13
- Plans covering
- 27
- Coverage rate
- 0.5%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 61
- Total spending
- $9,826
- Avg per beneficiary
- $161.08
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 1 ML medroxyprogesterone acetate 150 MG/ML Prefilled Syringe [Depo-Provera]
27 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | ALAMEDA ALLIANCE FOR HEALTH | T1 | No | $0 | CA |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $34.50 | NY |
| Troy Medicare (HMO) | TROY HEALTH, INC. | T3 | No | $0 | NC |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | TROY HEALTH, INC. | T3 | No | $0 | NC |
| Contra Costa Health Care Plus (HMO D-SNP) | CONTRA COSTA COUNTY MEDICAL SERVICE DBA CONTRA COSTA HEALTH | T3 | No | $0 | CA |
| Keystone First VIP Choice (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T3 | No | $0 | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T3 | No | $0 | PA |
| First Choice VIP Care (HMO D-SNP) | SELECT HEALTH OF SOUTH CAROLINA, INC. | T3 | No | $0 | SC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T3 | No | $0 | DE |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T3 | No | $0 | DE |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS FLORIDA INC | T3 | No | $0 | FL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS LOUISIANA, INC. | T3 | No | $0 | LA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS NORTH CAROLINA, INC. | T3 | No | $0 | NC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH MICHIGAN, INC. | T3 | No | $0 | MI |
| Health First Rewards H1099-014 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | No | $0 | FL |
| Health First SunSaver H1099-016 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | No | $0 | FL |
| Health First Complete Care H1099-023 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | No | $0 | FL |
| Health First Emerald Plus H1099-024 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | No | $0 | FL |
| Health First Premier Access H1099-025 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T4 | No | $0 | FL |
| Health First Emerald Plus H1099-026 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | No | $0 | FL |
| Health First Premier Access H1099-027 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T4 | No | $0 | FL |
| Health First Emerald Plus H1099-028 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | No | $0 | FL |
| Health First Value H1099-006 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | No | $15.00 | FL |
| Health First Classic H1099-001 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T4 | No | $49.40 | FL |
Frequently Asked Questions
Is 1 ML medroxyprogesterone acetate 150 MG/ML Prefilled Syringe [Depo-Provera] covered by Medicare Part D?
Yes, 1 ML medroxyprogesterone acetate 150 MG/ML Prefilled Syringe [Depo-Provera] is covered by 27 Medicare Part D plans (0.5% of all Part D formularies).
What tier is 1 ML medroxyprogesterone acetate 150 MG/ML Prefilled Syringe [Depo-Provera] on Medicare Part D plans?
1 ML medroxyprogesterone acetate 150 MG/ML Prefilled Syringe [Depo-Provera] averages Tier 2.6 across Part D plans, ranging from Tier 1 to Tier 4.
Does 1 ML medroxyprogesterone acetate 150 MG/ML Prefilled Syringe [Depo-Provera] require prior authorization?
0% of Part D formularies require prior authorization for 1 ML medroxyprogesterone acetate 150 MG/ML Prefilled Syringe [Depo-Provera]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on 1 ML medroxyprogesterone acetate 150 MG/ML Prefilled Syringe [Depo-Provera]?
In 2023, total Medicare Part D spending on 1 ML medroxyprogesterone acetate 150 MG/ML Prefilled Syringe [Depo-Provera] was $9,826, covering 61 beneficiaries. The average spend per beneficiary was $161.08.
Read our methodology - how this data is sourced, computed, and verified.