Medicare Part D coverage · 4-Month · RxCUI 1946522
4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron]
Per the CMS 2026 Part D formulary file, 4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron] is covered by 2,029 Medicare Part D plans (40.2% of enrollable products), averaging Tier 4.2, with prior authorization required on 85.1% of covering formularies.
- 40.2%
- Plan coverage
- 2,029
- Plans covering
- T4.2
- Avg tier
- 85.1%
- Prior auth required
What the CMS Formulary Data Shows for 4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron]
Per the CMS 2026 Part D formulary file, 4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron] (RxNorm concept RXCUI 1946522, generic name 4-Month) appears on 148 distinct formulary files spanning 2,029 Medicare Part D plan offerings - 40.2% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 4.2.
Real-world access to 4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron] depends on utilization management as much as tier placement: 85.1% of covering formularies require prior authorization. 0% require step therapy. 27.7% 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 4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron] today.
Coverage Details
- Formularies covering
- 148
- Plans covering
- 2,029
- Coverage rate
- 40.2%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 85.1% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 27.7% of formularies
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering 4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron]
9 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering 4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron]
91 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 |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| 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 |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | Yes | $0 | CO |
| 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 | Yes | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $0 | NY |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | Yes | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | Yes | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $0 | MO |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $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 | Yes | $0 | WI |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
Show the next 30 plans
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Advance (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Plus (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| 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 | Yes | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | Yes | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $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 |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | Yes | $4.80 | TX |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Tribute Select (HMO-POS I-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $8.90 | AR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $13.10 | PA |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Illinois | T1 | Yes | $15.20 | IL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | Yes | $17.00 | AZ |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $17.60 | PA |
| Alterwood Advantage Dual Value (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $31.20 | MD |
| Highmark Health Options Duals Select (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $31.20 | DE |
| Valor Health Plan (HMO I-SNP) | TSG Guard, Inc. | T1 | Yes | $31.40 | OH |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $32.70 | PA |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $32.70 | PA |
| WV Senior Advantage (HMO I-SNP) | West Virginia Senior Advantage, Inc. | T1 | Yes | $32.70 | WV |
Showing top 50 of 91 plans.
Frequently Asked Questions
Is 4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron] covered by Medicare Part D?
Yes, 4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron] is covered by 2,029 Medicare Part D plans (40.2% of all Part D formularies).
What tier is 4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron] on Medicare Part D plans?
4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 6.
Does 4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron] require prior authorization?
85.1% of Part D formularies require prior authorization for 4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron]. Step therapy: 0%. Quantity limits: 27.7%.
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
- 0.5 ML peginterferon alfa-2a 0.36 MG/ML Prefilled Syringe [Pegasys] T4.2
- 1 ML etanercept 50 MG/ML Prefilled Syringe [Enbrel] T4.2
- 12 HR fostemsavir 600 MG Extended Release Oral Tablet [Rukobia] T4.2
- {14 (venetoclax 10 MG Oral Tablet [Venclexta]) / 21 (venetoclax 100 MG Oral Tablet [Venclexta]) / 7 (venetoclax 50 MG Oral Tablet [Venclexta]) } Pack [Venclexta Starting Pack] T4.2
- 1.5 ML elapegademase-lvlr 1.6 MG/ML Injection [Revcovi] T4.2
- {16 (tovorafenib 100 MG Oral Tablet [Ojemda]) } Pack [Ojemda 400 MG Once Weekly Carton] T4.2
Similar prior-authorization rate
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