amylase 30250 UNT / lipase 8000 UNT / protease 28750 UNT Delayed Release Oral Capsule [Pertzye]
amylase
RxCUI: 1294483
What the CMS Formulary Data Shows for amylase 30250 UNT / lipase 8000 UNT / protease 28750 UNT Delayed Release Oral Capsule [Pertzye]
Per the CMS 2026 Part D formulary file, amylase 30250 UNT / lipase 8000 UNT / protease 28750 UNT Delayed Release Oral Capsule [Pertzye] (RxNorm concept RXCUI 1294483, generic name amylase) appears on 2 distinct formulary files spanning 3 Medicare Part D plan offerings - 0.1% 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.
Real-world access to amylase 30250 UNT / lipase 8000 UNT / protease 28750 UNT Delayed Release Oral Capsule [Pertzye] depends on utilization management as much as tier placement: 50% 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 320 Part D beneficiaries filled amylase 30250 UNT / lipase 8000 UNT / protease 28750 UNT Delayed Release Oral Capsule [Pertzye] in 2023, with total plan-and-beneficiary spending of $6,564,873 and an average per-beneficiary annual cost of $20,515.23. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry amylase 30250 UNT / lipase 8000 UNT / protease 28750 UNT Delayed Release Oral Capsule [Pertzye] today.
Coverage Details
- Formularies covering
- 2
- Plans covering
- 3
- Coverage rate
- 0.1%
- Tier range
- Tier 2 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 50% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 320
- Total spending
- $6,564,873
- Avg per beneficiary
- $20,515.23
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering amylase 30250 UNT / lipase 8000 UNT / protease 28750 UNT Delayed Release Oral Capsule [Pertzye]
3 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 | Yes | $0 | CA |
| FHCP Medicare Classic (HMO) | FLORIDA BLUE MEDICARE, INC. | T4 | No | $0 | FL |
| FHCP Medicare Rx Plus (HMO-POS) | FLORIDA BLUE MEDICARE, INC. | T4 | No | $49.00 | FL |
Frequently Asked Questions
Is amylase 30250 UNT / lipase 8000 UNT / protease 28750 UNT Delayed Release Oral Capsule [Pertzye] covered by Medicare Part D?
Yes, amylase 30250 UNT / lipase 8000 UNT / protease 28750 UNT Delayed Release Oral Capsule [Pertzye] is covered by 3 Medicare Part D plans (0.1% of all Part D formularies).
What tier is amylase 30250 UNT / lipase 8000 UNT / protease 28750 UNT Delayed Release Oral Capsule [Pertzye] on Medicare Part D plans?
amylase 30250 UNT / lipase 8000 UNT / protease 28750 UNT Delayed Release Oral Capsule [Pertzye] averages Tier 3 across Part D plans, ranging from Tier 2 to Tier 4.
Does amylase 30250 UNT / lipase 8000 UNT / protease 28750 UNT Delayed Release Oral Capsule [Pertzye] require prior authorization?
50% of Part D formularies require prior authorization for amylase 30250 UNT / lipase 8000 UNT / protease 28750 UNT Delayed Release Oral Capsule [Pertzye]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on amylase 30250 UNT / lipase 8000 UNT / protease 28750 UNT Delayed Release Oral Capsule [Pertzye]?
In 2023, total Medicare Part D spending on amylase 30250 UNT / lipase 8000 UNT / protease 28750 UNT Delayed Release Oral Capsule [Pertzye] was $6,564,873, covering 320 beneficiaries. The average spend per beneficiary was $20,515.23.
Read our methodology - how this data is sourced, computed, and verified.