Medicare Part D coverage · 168 · RxCUI 545276
168 HR estradiol 0.000583 MG/HR Transdermal System [Menostar]
Per the CMS 2026 Part D formulary file, 168 HR estradiol 0.000583 MG/HR Transdermal System [Menostar] is covered by 26 Medicare Part D plans (0.5% of enrollable products), averaging Tier 3.5, with prior authorization required on 25% of covering formularies.
- 0.5%
- Plan coverage
- 26
- Plans covering
- T3.5
- Avg tier
- 25%
- Prior auth required
What the CMS Formulary Data Shows for 168 HR estradiol 0.000583 MG/HR Transdermal System [Menostar]
Per the CMS 2026 Part D formulary file, 168 HR estradiol 0.000583 MG/HR Transdermal System [Menostar] (RxNorm concept RXCUI 545276, generic name 168) appears on 4 distinct formulary files spanning 26 Medicare Part D plan offerings - 0.5% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 2 to Tier 4, with a cross-plan average of Tier 3.5.
Real-world access to 168 HR estradiol 0.000583 MG/HR Transdermal System [Menostar] depends on utilization management as much as tier placement: 25% 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 404 Part D beneficiaries filled 168 HR estradiol 0.000583 MG/HR Transdermal System [Menostar] in 2023, with total plan-and-beneficiary spending of $611,837 and an average per-beneficiary annual cost of $1,514.45. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 168 HR estradiol 0.000583 MG/HR Transdermal System [Menostar] today.
Coverage Details
- Formularies covering
- 4
- Plans covering
- 26
- Coverage rate
- 0.5%
- Tier range
- Tier 2 – Tier 4
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 25% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 404
- Total spending
- $611,837
- Avg per beneficiary
- $1,514.45
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 168 HR estradiol 0.000583 MG/HR Transdermal System [Menostar]
26 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T2 | No | $0 | CA |
| Network Health Select (PPO) | Network Health Insurance Corporation | T4 | No | $0 | WI |
| Network Health Go (PPO) | Network Health Insurance Corporation | T4 | No | $0 | WI |
| Network Health Anywhere (PPO) | Network Health Insurance Corporation | T4 | No | $0 | WI |
| Network Health Choice (PPO) | Network Health Insurance Corporation | T4 | No | $0 | WI |
| Network Health Zero (PPO) | Network Health Insurance Corporation | T4 | No | $0 | WI |
| PacificSource Medicare Essentials Rx 27 (HMO) | Pacificsource Community Health Plans | T4 | No | $0 | OR |
| PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) | Pacificsource Community Health Plans | T4 | No | $0 | MT |
| PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) | Pacificsource Community Health Plans | T4 | No | $0 | OR |
| PacificSource Medicare MyCare Rx 40 (HMO) | Pacificsource Community Health Plans | T4 | No | $0 | OR |
| PacificSource Dual Care (HMO D-SNP) | Pacificsource Community Health Plans | T4 | No | $0 | OR |
| PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) | Pacificsource Community Health Plans | T4 | No | $19.00 | ID |
| Network Health Cares (PPO D-SNP) | Network Health Insurance Corporation | T4 | No | $21.10 | WI |
| PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) | Pacificsource Community Health Plans | T4 | No | $29.10 | OR |
| Network Health PlusRx (PPO) | Network Health Insurance Corporation | T4 | No | $38.60 | WI |
| Keystone 65 Select Rx (HMO) | Keystone Health Plan East, Inc. | T4 | Yes | $47.00 | PA |
| PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) | Pacificsource Community Health Plans | T4 | No | $52.00 | ID |
| Keystone 65 Preferred Rx (HMO) | Keystone Health Plan East, Inc. | T4 | Yes | $59.70 | PA |
| Keystone 65 Select Rx (HMO) | Keystone Health Plan East, Inc. | T4 | Yes | $63.50 | PA |
| PacificSource Medicare Essentials Rx 41 (HMO) | Pacificsource Community Health Plans | T4 | No | $69.30 | OR |
Show the next 6 plans
| Keystone 65 Preferred Rx (HMO) | Keystone Health Plan East, Inc. | T4 | Yes | $79.70 | PA |
| PacificSource Medicare Explorer Rx 4 (PPO) | Pacificsource Community Health Plans | T4 | No | $88.70 | OR |
| Network Health PremierRx (PPO) | Network Health Insurance Corporation | T4 | No | $92.80 | WI |
| Personal Choice 65 Rx (PPO) | QCC Insurance Company | T4 | Yes | $102.20 | PA |
| PacificSource Medicare Essentials Rx 6 (HMO) | Pacificsource Community Health Plans | T4 | No | $105.90 | OR |
| Personal Choice 65 Rx (PPO) | QCC Insurance Company | T4 | Yes | $112.70 | PA |
Frequently Asked Questions
Is 168 HR estradiol 0.000583 MG/HR Transdermal System [Menostar] covered by Medicare Part D?
Yes, 168 HR estradiol 0.000583 MG/HR Transdermal System [Menostar] is covered by 26 Medicare Part D plans (0.5% of all Part D formularies).
What tier is 168 HR estradiol 0.000583 MG/HR Transdermal System [Menostar] on Medicare Part D plans?
168 HR estradiol 0.000583 MG/HR Transdermal System [Menostar] averages Tier 3.5 across Part D plans, ranging from Tier 2 to Tier 4.
Does 168 HR estradiol 0.000583 MG/HR Transdermal System [Menostar] require prior authorization?
25% of Part D formularies require prior authorization for 168 HR estradiol 0.000583 MG/HR Transdermal System [Menostar]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on 168 HR estradiol 0.000583 MG/HR Transdermal System [Menostar]?
In 2023, total Medicare Part D spending on 168 HR estradiol 0.000583 MG/HR Transdermal System [Menostar] was $611,837, covering 404 beneficiaries. The average spend per beneficiary was $1,514.45.
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
- lomustine 40 MG Oral Capsule T3.5
- 1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia] T3.5
- tretinoin 0.001 MG/MG Topical Gel T3.5
- ethacrynic acid 25 MG Oral Tablet T3.5
- daridorexant 25 MG Oral Tablet [Quviviq] T3.5
- 24 HR canagliflozin 150 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Invokamet] T3.5
Similar prior-authorization rate
- lorazepam 0.5 MG Oral Tablet 25% PA
- insulin lispro-aabc 100 UNT/ML Injectable Solution [Lyumjev] 25% PA
- desipramine hydrochloride 10 MG Oral Tablet 25% PA
- desipramine hydrochloride 100 MG Oral Tablet 25% PA
- methotrexate 5 MG Oral Tablet [Trexall] 25% PA
- tiopronin 100 MG Delayed Release Oral Tablet [Venxxiva] 25% PA