200 ACTUAT levalbuterol 0.045 MG/ACTUAT Metered Dose Inhaler [Xopenex]
RxCUI: 746466
What the CMS Formulary Data Shows for 200 ACTUAT levalbuterol 0.045 MG/ACTUAT Metered Dose Inhaler [Xopenex]
Per the CMS 2026 Part D formulary file, 200 ACTUAT levalbuterol 0.045 MG/ACTUAT Metered Dose Inhaler [Xopenex] (RxNorm concept RXCUI 746466) appears on 15 distinct formulary files spanning 105 Medicare Part D plan offerings - 2.1% 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 3.2.
Real-world access to 200 ACTUAT levalbuterol 0.045 MG/ACTUAT Metered Dose Inhaler [Xopenex] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 100% 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 200 ACTUAT levalbuterol 0.045 MG/ACTUAT Metered Dose Inhaler [Xopenex] today.
Coverage Details
- Formularies covering
- 15
- Plans covering
- 105
- Coverage rate
- 2.1%
- 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
- 100% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 200 ACTUAT levalbuterol 0.045 MG/ACTUAT Metered Dose Inhaler [Xopenex]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | No | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | No | $0 | MN |
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | HCSC INSURANCE SERVICES COMPANY | T1 | No | $4.80 | TX |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS INSURANCE COMPANY | T1 | No | $5.00 | OK |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $34.50 | NY |
| Blue Medicare Essential Plus (HMO-POS) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | T4 | No | $0 | NC |
| Blue Medicare Choice (HMO) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | T4 | No | $0 | NC |
| Blue Medicare Essential (HMO) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | T4 | No | $0 | NC |
| Experience Health Medicare Advantage (HMO) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | T4 | No | $0 | NC |
| Healthy Blue + Medicare (HMO-POS D-SNP) | BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH | T4 | No | $0 | NC |
| Blue Advantage Complete (PPO) | BLUE CROSS AND BLUE SHIELD OF ALABAMA | T4 | No | $0 | AL |
| BSW SeniorCare Advantage (PPO) | Baylor Scott & White Insurance Company | T4 | No | $0 | TX |
| BSW SeniorCare Advantage Basic (PPO) | Baylor Scott & White Insurance Company | T4 | No | $0 | TX |
| BSW SeniorCare Advantage (PPO) | Baylor Scott & White Insurance Company | T4 | No | $0 | TX |
| BSW SeniorCare Advantage Select Rx (HMO-POS) | SCOTT AND WHITE HEALTH PLAN | T4 | No | $0 | TX |
| BSW SeniorCare Advantage Premium Rx (HMO-POS) | SCOTT AND WHITE HEALTH PLAN | T4 | No | $0 | TX |
| BSW SeniorCare Advantage Select Rx (HMO-POS) | SCOTT AND WHITE HEALTH PLAN | T4 | No | $0 | TX |
| Blue Cross Medicare Advantage Classic (PPO) | Health Care Service Corporation | T4 | No | $0 | MT |
| Blue Cross Medicare Advantage Choice Plus (PPO) | HCSC INSURANCE SERVICES COMPANY | T4 | No | $0 | TX |
| Blue Cross Medicare Advantage Choice Plus (PPO) | HCSC INSURANCE SERVICES COMPANY | T4 | No | $0 | TX |
| Blue Cross Medicare Advantage Balance (PPO) | HCSC INSURANCE SERVICES COMPANY | T4 | No | $0 | NM |
| Blue Cross Medicare Advantage Optimum (PPO) | HCSC INSURANCE SERVICES COMPANY | T4 | No | $0 | NM |
| Blue Cross Medicare Advantage Access (PPO) | HCSC INSURANCE SERVICES COMPANY | T4 | No | $0 | NM |
| Blue Cross Medicare Advantage Select (HMO) | Health Care Service Corporation | T4 | No | $0 | NM |
| Blue Cross Medicare Advantage Basic (HMO) | Health Care Service Corporation | T4 | No | $0 | IL |
| Blue Cross Medicare Advantage Basic (HMO) | Health Care Service Corporation | T4 | No | $0 | NM |
| Blue Cross Medicare Advantage Basic Plus (HMO-POS) | Health Care Service Corporation | T4 | No | $0 | IL |
| Blue Cross Medicare Advantage Basic (HMO) | Health Care Service Corporation | T4 | No | $0 | IL |
| Blue Cross Medicare Advantage Value (HMO) | Health Care Service Corporation | T4 | No | $0 | IL |
| Blue Cross Medicare Advantage Basic (HMO) | GHS HEALTH MAINTENANCE ORGANIZATION, INC. | T4 | No | $0 | OK |
| Blue Cross Medicare Advantage Basic (HMO) | GHS INSURANCE COMPANY | T4 | No | $0 | TX |
| Blue Cross Medicare Advantage Secure (HMO) | ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY | T4 | No | $0 | IL |
| Blue Cross Medicare Advantage Core (HMO) | GHS INSURANCE COMPANY | T4 | No | $0 | TX |
| Blue Cross Medicare Advantage Classic (PPO) | Health Care Service Corporation | T4 | No | $0 | NM |
| Blue Cross Medicare Advantage Essential (PPO) | Health Care Service Corporation | T4 | No | $0 | IL |
| Blue Cross Medicare Advantage Classic (PPO) | Health Care Service Corporation | T4 | No | $0 | OK |
| Blue Cross Medicare Advantage Value (HMO) | HCSC INSURANCE SERVICES COMPANY | T4 | No | $0 | TX |
| Blue Medicare Advantage (PPO) | BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC. | T4 | No | $0 | KS |
| Blue Medicare Advantage Choice (PPO) | BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC. | T4 | No | $0 | KS |
| Blue Cross and Blue Shield of Nebraska MA Core (HMO) | SAPPHIRE EDGE, INC. | T4 | No | $0 | NE |
| Solis Guardian Plan (HMO D-SNP) | SOLIS HEALTH PLANS, INC. | T4 | No | $0 | FL |
| Solis Healthy Living Plan (HMO) | SOLIS HEALTH PLANS, INC. | T4 | No | $0 | FL |
| Solis Healthy Living Plan (HMO) | SOLIS HEALTH PLANS, INC. | T4 | No | $0 | FL |
| Solis Healthy Living Plan (HMO) | SOLIS HEALTH PLANS, INC. | T4 | No | $0 | FL |
| Solis Wellness Plan (HMO C-SNP) | SOLIS HEALTH PLANS, INC. | T4 | No | $0 | FL |
| Solis Wellness Plan (HMO C-SNP) | SOLIS HEALTH PLANS, INC. | T4 | No | $0 | FL |
| Solis Wellness Plan (HMO C-SNP) | SOLIS HEALTH PLANS, INC. | T4 | No | $0 | FL |
Frequently Asked Questions
Is 200 ACTUAT levalbuterol 0.045 MG/ACTUAT Metered Dose Inhaler [Xopenex] covered by Medicare Part D?
Yes, 200 ACTUAT levalbuterol 0.045 MG/ACTUAT Metered Dose Inhaler [Xopenex] is covered by 105 Medicare Part D plans (2.1% of all Part D formularies).
What tier is 200 ACTUAT levalbuterol 0.045 MG/ACTUAT Metered Dose Inhaler [Xopenex] on Medicare Part D plans?
200 ACTUAT levalbuterol 0.045 MG/ACTUAT Metered Dose Inhaler [Xopenex] averages Tier 3.2 across Part D plans, ranging from Tier 1 to Tier 4.
Does 200 ACTUAT levalbuterol 0.045 MG/ACTUAT Metered Dose Inhaler [Xopenex] require prior authorization?
0% of Part D formularies require prior authorization for 200 ACTUAT levalbuterol 0.045 MG/ACTUAT Metered Dose Inhaler [Xopenex]. Step therapy: 0%. Quantity limits: 100%.
Read our methodology - how this data is sourced, computed, and verified.