Medicare Part D coverage · {28 · RxCUI 1000500
{28 (estrogens, conjugated (USP) 0.625 MG / medroxyprogesterone acetate 5 MG Oral Tablet) } Pack [Prempro 0.625/5 28 Day]
Per the CMS 2026 Part D formulary file, {28 (estrogens, conjugated (USP) 0.625 MG / medroxyprogesterone acetate 5 MG Oral Tablet) } Pack [Prempro 0.625/5 28 Day] is covered by 2,730 Medicare Part D plans (54% of enrollable products), averaging Tier 2.7, with prior authorization required on 17.8% of covering formularies.
- 54%
- Plan coverage
- 2,730
- Plans covering
- T2.7
- Avg tier
- 17.8%
- Prior auth required
What the CMS Formulary Data Shows for {28 (estrogens, conjugated (USP) 0.625 MG / medroxyprogesterone acetate 5 MG Oral Tablet) } Pack [Prempro 0.625/5 28 Day]
Per the CMS 2026 Part D formulary file, {28 (estrogens, conjugated (USP) 0.625 MG / medroxyprogesterone acetate 5 MG Oral Tablet) } Pack [Prempro 0.625/5 28 Day] (RxNorm concept RXCUI 1000500, generic name {28) appears on 213 distinct formulary files spanning 2,730 Medicare Part D plan offerings - 54% 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 2.7.
Real-world access to {28 (estrogens, conjugated (USP) 0.625 MG / medroxyprogesterone acetate 5 MG Oral Tablet) } Pack [Prempro 0.625/5 28 Day] depends on utilization management as much as tier placement: 17.8% of covering formularies require prior authorization. 0% require step therapy. 2.3% 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 {28 (estrogens, conjugated (USP) 0.625 MG / medroxyprogesterone acetate 5 MG Oral Tablet) } Pack [Prempro 0.625/5 28 Day] today.
Coverage Details
- Formularies covering
- 213
- Plans covering
- 2,730
- Coverage rate
- 54%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 17.8% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 2.3% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering {28 (estrogens, conjugated (USP) 0.625 MG / medroxyprogesterone acetate 5 MG Oral Tablet) } Pack [Prempro 0.625/5 28 Day]
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 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $0 | NJ |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | No | $0 | GA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | No | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | No | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | No | $0 | AL |
| 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 |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| 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 |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | No | $0 | CO |
Show the next 30 plans
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | Yes | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | No | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | No | $0 | NY |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $0 | MO |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | No | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $0 | AR |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $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 |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | No | $4.80 | FL |
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | No | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | No | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | No | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | American Health Plan OF FL, Inc. | T1 | No | $4.80 | FL |
| SECUR Advantage (HMO I-SNP) | Secur Inc | T1 | No | $4.80 | FL |
| SECUR Enhanced (HMO I-SNP) | Secur Inc | T1 | No | $4.80 | FL |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Hcsc Insurance Services Company | T1 | No | $4.80 | TX |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | No | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | No | $4.80 | TX |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | No | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | No | $4.80 | TX |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is {28 (estrogens, conjugated (USP) 0.625 MG / medroxyprogesterone acetate 5 MG Oral Tablet) } Pack [Prempro 0.625/5 28 Day] covered by Medicare Part D?
Yes, {28 (estrogens, conjugated (USP) 0.625 MG / medroxyprogesterone acetate 5 MG Oral Tablet) } Pack [Prempro 0.625/5 28 Day] is covered by 2,730 Medicare Part D plans (54% of all Part D formularies).
What tier is {28 (estrogens, conjugated (USP) 0.625 MG / medroxyprogesterone acetate 5 MG Oral Tablet) } Pack [Prempro 0.625/5 28 Day] on Medicare Part D plans?
{28 (estrogens, conjugated (USP) 0.625 MG / medroxyprogesterone acetate 5 MG Oral Tablet) } Pack [Prempro 0.625/5 28 Day] averages Tier 2.7 across Part D plans, ranging from Tier 1 to Tier 4.
Does {28 (estrogens, conjugated (USP) 0.625 MG / medroxyprogesterone acetate 5 MG Oral Tablet) } Pack [Prempro 0.625/5 28 Day] require prior authorization?
17.8% of Part D formularies require prior authorization for {28 (estrogens, conjugated (USP) 0.625 MG / medroxyprogesterone acetate 5 MG Oral Tablet) } Pack [Prempro 0.625/5 28 Day]. Step therapy: 0%. Quantity limits: 2.3%.
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
- cyclosporine, modified 25 MG Oral Capsule T2.7
- insulin aspart, human 100 UNT/ML Injectable Solution [NovoLog] T2.7
- insulin glargine 100 UNT/ML Injectable Solution [Lantus] T2.7
- theophylline 450 MG Extended Release Oral Tablet T2.7
- 24 HR amphetamine aspartate 1.25 MG / amphetamine sulfate 1.25 MG / dextroamphetamine saccharate 1.25 MG / dextroamphetamine sulfate 1.25 MG Extended Release Oral Capsule T2.7
- ampicillin 1000 MG / sulbactam 500 MG Injection T2.7
Similar prior-authorization rate
- adapalene 1 MG/ML Topical Cream 17.8% PA
- penicillamine 250 MG Oral Capsule 17.9% PA
- 24 HR paliperidone 9 MG Extended Release Oral Tablet 17.7% PA
- 24 HR paliperidone 3 MG Extended Release Oral Tablet 17.7% PA
- itraconazole 100 MG Oral Capsule 17.7% PA
- perfluorohexyloctane 1340 MG/ML Ophthalmic Solution [Miebo] 17.7% PA