273 DAY ethinyl estradiol 0.000542 MG/HR / segesterone acetate 0.00625 MG/HR Vaginal System [Annovera]
RxCUI: 2055989
What the CMS Formulary Data Shows for 273 DAY ethinyl estradiol 0.000542 MG/HR / segesterone acetate 0.00625 MG/HR Vaginal System [Annovera]
Per the CMS 2026 Part D formulary file, 273 DAY ethinyl estradiol 0.000542 MG/HR / segesterone acetate 0.00625 MG/HR Vaginal System [Annovera] (RxNorm concept RXCUI 2055989) appears on 7 distinct formulary files spanning 40 Medicare Part D plan offerings - 0.8% 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 3.3.
Real-world access to 273 DAY ethinyl estradiol 0.000542 MG/HR / segesterone acetate 0.00625 MG/HR Vaginal System [Annovera] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 85.7% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 44 Part D beneficiaries filled 273 DAY ethinyl estradiol 0.000542 MG/HR / segesterone acetate 0.00625 MG/HR Vaginal System [Annovera] in 2023, with total plan-and-beneficiary spending of $110,515 and an average per-beneficiary annual cost of $2,511.70. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 273 DAY ethinyl estradiol 0.000542 MG/HR / segesterone acetate 0.00625 MG/HR Vaginal System [Annovera] today.
Coverage Details
- Formularies covering
- 7
- Plans covering
- 40
- Coverage rate
- 0.8%
- Tier range
- Tier 2 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 85.7% of formularies
2023 Medicare Spending
- Beneficiaries
- 44
- Total spending
- $110,515
- Avg per beneficiary
- $2,511.70
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 273 DAY ethinyl estradiol 0.000542 MG/HR / segesterone acetate 0.00625 MG/HR Vaginal System [Annovera]
40 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| CareAdvantage (HMO D-SNP) | SAN MATEO HEALTH COMMISSION | T2 | No | $0 | CA |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | No | $0 | CA |
| DrMax (HMO) | DOCTORS HEALTHCARE PLANS, INC. | T3 | No | $0 | FL |
| DrExtraCare (HMO C-SNP) | DOCTORS HEALTHCARE PLANS, INC. | T3 | No | $0 | FL |
| DrSelect (HMO) | DOCTORS HEALTHCARE PLANS, INC. | T3 | No | $0 | FL |
| DrSelect-CFL (HMO) | DOCTORS HEALTHCARE PLANS, INC. | T3 | No | $0 | FL |
| DrPlatinum-CFL (HMO D-SNP) | DOCTORS HEALTHCARE PLANS, INC. | T3 | No | $0 | FL |
| DrTotalCare-CFL (HMO C-SNP) | DOCTORS HEALTHCARE PLANS, INC. | T3 | No | $0 | FL |
| DrElite-SFL (HMO) | DOCTORS HEALTHCARE PLANS, INC. | T3 | No | $0 | FL |
| DrFlex (HMO D-SNP) | DOCTORS HEALTHCARE PLANS, INC. | T3 | No | $1.10 | FL |
| DrPlus (HMO D-SNP) | DOCTORS HEALTHCARE PLANS, INC. | T3 | No | $4.80 | FL |
| Medicare BlueEssential (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Medicare BlueActive (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Medicare BlueVital (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Univera SeniorChoice Basic (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Univera SeniorChoice Extra (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Medicare Blue Choice Core (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Univera Medicare Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T4 | No | $0 | NY |
| Medicare Blue Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T4 | No | $0 | NY |
| Geisinger Gold Preferred Complete Rx (PPO) | GEISINGER INDEMNITY INSURANCE COMPANY | T4 | No | $0 | PA |
| Geisinger Gold Secure Rx (HMO D-SNP) | GEISINGER HEALTH PLAN | T4 | No | $0 | PA |
| Geisinger Gold Classic 360 Rx (HMO) | GEISINGER HEALTH PLAN | T4 | No | $0 | PA |
| Geisinger Gold Classic Essential Rx (HMO) | GEISINGER HEALTH PLAN | T4 | No | $0 | PA |
| CDPHP $0 Medicare Rx (HMO) | CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Geisinger Gold Value Rx (HMO) | GEISINGER HEALTH PLAN | T4 | No | $23.00 | PA |
| Univera SeniorChoice Core (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $33.00 | NY |
| Univera SeniorChoice Advanced (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $36.90 | NY |
| Geisinger Gold Classic Complete Rx (HMO) | GEISINGER HEALTH PLAN | T4 | No | $48.00 | PA |
| Medicare BlueClassic (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $51.00 | NY |
| Univera SeniorChoice Secure (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $54.90 | NY |
| Medicare BlueBalanced (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $55.00 | NY |
| Medicare Blue Choice Prime (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $55.00 | NY |
| Univera SeniorChoice Value Plus (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $58.60 | NY |
| Medicare BlueEnhanced (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $70.30 | NY |
| Medicare BluePlus (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $86.40 | NY |
| Geisinger Gold Classic Advantage Rx (HMO) | GEISINGER HEALTH PLAN | T4 | No | $99.30 | PA |
| CDPHP Clear Rx (HMO) | CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | T4 | No | $100.00 | NY |
| Geisinger Gold Preferred Advantage Rx (PPO) | GEISINGER INDEMNITY INSURANCE COMPANY | T4 | No | $112.00 | PA |
| CDPHP Choice Rx (HMO) | CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | T4 | No | $135.00 | NY |
| Medicare Blue Choice Optimum (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $146.00 | NY |
Frequently Asked Questions
Is 273 DAY ethinyl estradiol 0.000542 MG/HR / segesterone acetate 0.00625 MG/HR Vaginal System [Annovera] covered by Medicare Part D?
Yes, 273 DAY ethinyl estradiol 0.000542 MG/HR / segesterone acetate 0.00625 MG/HR Vaginal System [Annovera] is covered by 40 Medicare Part D plans (0.8% of all Part D formularies).
What tier is 273 DAY ethinyl estradiol 0.000542 MG/HR / segesterone acetate 0.00625 MG/HR Vaginal System [Annovera] on Medicare Part D plans?
273 DAY ethinyl estradiol 0.000542 MG/HR / segesterone acetate 0.00625 MG/HR Vaginal System [Annovera] averages Tier 3.3 across Part D plans, ranging from Tier 2 to Tier 4.
Does 273 DAY ethinyl estradiol 0.000542 MG/HR / segesterone acetate 0.00625 MG/HR Vaginal System [Annovera] require prior authorization?
0% of Part D formularies require prior authorization for 273 DAY ethinyl estradiol 0.000542 MG/HR / segesterone acetate 0.00625 MG/HR Vaginal System [Annovera]. Step therapy: 0%. Quantity limits: 85.7%.
How much does Medicare spend on 273 DAY ethinyl estradiol 0.000542 MG/HR / segesterone acetate 0.00625 MG/HR Vaginal System [Annovera]?
In 2023, total Medicare Part D spending on 273 DAY ethinyl estradiol 0.000542 MG/HR / segesterone acetate 0.00625 MG/HR Vaginal System [Annovera] was $110,515, covering 44 beneficiaries. The average spend per beneficiary was $2,511.70.
Read our methodology - how this data is sourced, computed, and verified.