Medicare Part D coverage · 1250 · RxCUI 1597120
1250 MG testosterone 0.0162 MG/MG Topical Gel
Per the CMS 2026 Part D formulary file, 1250 MG testosterone 0.0162 MG/MG Topical Gel is covered by 2,591 Medicare Part D plans (51.3% of enrollable products), averaging Tier 3.1, with prior authorization required on 85% of covering formularies.
- 51.3%
- Plan coverage
- 2,591
- Plans covering
- T3.1
- Avg tier
- 85%
- Prior auth required
What the CMS Formulary Data Shows for 1250 MG testosterone 0.0162 MG/MG Topical Gel
Per the CMS 2026 Part D formulary file, 1250 MG testosterone 0.0162 MG/MG Topical Gel (RxNorm concept RXCUI 1597120, generic name 1250) appears on 133 distinct formulary files spanning 2,591 Medicare Part D plan offerings - 51.3% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 3.1.
Real-world access to 1250 MG testosterone 0.0162 MG/MG Topical Gel depends on utilization management as much as tier placement: 85% of covering formularies require prior authorization. 0% require step therapy. 70.7% 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 1250 MG testosterone 0.0162 MG/MG Topical Gel today.
Coverage Details
- Formularies covering
- 133
- Plans covering
- 2,591
- Coverage rate
- 51.3%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 85% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 70.7% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 1250 MG testosterone 0.0162 MG/MG Topical Gel
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | Yes | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | Yes | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | Yes | $0 | NJ |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | Yes | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | Yes | $0 | GA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | Yes | $0 | MI |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | Yes | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | Yes | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | Yes | $0 | CA |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | Yes | $0 | CA |
Show the next 30 plans
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | No | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | No | $0 | DE |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Hcsc Insurance Services Company | T1 | Yes | $4.80 | TX |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS Insurance Company | T1 | Yes | $5.00 | OK |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | Yes | $8.80 | MI |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $13.10 | PA |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Illinois, Inc. | T1 | Yes | $15.20 | IL |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $17.60 | PA |
| WellSense Added Value (HMO) | Boston Medical Center Health Plan, Inc. | T1 | Yes | $21.70 | NH |
| Highmark Health Options Duals Select (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | No | $31.20 | DE |
| Hamaspik Medicare Select (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $34.50 | NY |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Colorado, Inc. | T1 | Yes | $35.20 | CO |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF North Carolina, Inc. | T1 | Yes | $36.20 | NC |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | Yes | $40.00 | NJ |
| ElderServe Star (HMO I-SNP) | Elderserve Health, Inc. | T1 | Yes | $58.80 | NY |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF NEW York, Inc. | T1 | Yes | $58.80 | NY |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T2 | Yes | $0 | FL |
| HealthSun MediMax (HMO) | Healthsun Health Plans, Inc. | T2 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T2 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T2 | Yes | $0 | FL |
| HealthSun MediSun Plus (HMO D-SNP) | Healthsun Health Plans, Inc. | T2 | Yes | $0 | FL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 1250 MG testosterone 0.0162 MG/MG Topical Gel covered by Medicare Part D?
Yes, 1250 MG testosterone 0.0162 MG/MG Topical Gel is covered by 2,591 Medicare Part D plans (51.3% of all Part D formularies).
What tier is 1250 MG testosterone 0.0162 MG/MG Topical Gel on Medicare Part D plans?
1250 MG testosterone 0.0162 MG/MG Topical Gel averages Tier 3.1 across Part D plans, ranging from Tier 1 to Tier 4.
Does 1250 MG testosterone 0.0162 MG/MG Topical Gel require prior authorization?
85% of Part D formularies require prior authorization for 1250 MG testosterone 0.0162 MG/MG Topical Gel. Step therapy: 0%. Quantity limits: 70.7%.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
- aripiprazole 15 MG Disintegrating Oral Tablet T3.1
- isotretinoin 30 MG Oral Capsule [Amnesteem] T3.1
- Pulmonary Hypertension tadalafil 20 MG Oral Tablet [Alyq] T3.1
- dextroamphetamine sulfate 5 MG Extended Release Oral Capsule T3.1
- 24 HR pramipexole dihydrochloride 1.5 MG Extended Release Oral Tablet T3.1
- clindamycin 10 MG/ML Topical Foam T3.1
Similar prior-authorization rate
- 2500 MG testosterone 0.0162 MG/MG Topical Gel 85% PA
- 4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron] 85.1% PA
- pyrimethamine 25 MG Oral Tablet 84.8% PA
- 0.4 ML ofatumumab 50 MG/ML Pen Injector [Kesimpta] 84.8% PA
- quinine sulfate 324 MG Oral Capsule 84.8% PA
- Once-Daily gabapentin 600 MG Oral Tablet 84.8% PA