Medicare Part D coverage · cephalexin · RxCUI 637173
cephalexin 750 MG Oral Capsule
Per the CMS 2026 Part D formulary file, cephalexin 750 MG Oral Capsule is covered by 1,682 Medicare Part D plans (33.3% of enrollable products), averaging Tier 3, with prior authorization required on 0% of covering formularies.
- 33.3%
- Plan coverage
- 1,682
- Plans covering
- T3
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for cephalexin 750 MG Oral Capsule
Per the CMS 2026 Part D formulary file, cephalexin 750 MG Oral Capsule (RxNorm concept RXCUI 637173, generic name cephalexin) appears on 45 distinct formulary files spanning 1,682 Medicare Part D plan offerings - 33.3% 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.
Real-world access to cephalexin 750 MG Oral Capsule depends on utilization management as much as tier placement: 0% 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 5,051,787 Part D beneficiaries filled cephalexin 750 MG Oral Capsule in 2023, with total plan-and-beneficiary spending of $64,269,317 and an average per-beneficiary annual cost of $12.72. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry cephalexin 750 MG Oral Capsule today.
Coverage Details
- Formularies covering
- 45
- Plans covering
- 1,682
- Coverage rate
- 33.3%
- 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
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 5,051,787
- Total spending
- $64,269,317
- Avg per beneficiary
- $12.72
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering cephalexin 750 MG Oral Capsule
4 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP) | HM Health Insurance Company | T2 | No | No | $164.80 | - |
| Blue Rx PDP Plus (PDP) | HM Health Insurance Company | T2 | No | No | $193.20 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T3 | No | No | $0 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T3 | No | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering cephalexin 750 MG Oral Capsule
96 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 |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $0 | NY |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T1 | No | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T1 | No | $0 | NY |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| 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 |
| CareOregon Advantage Plus (HMO D-SNP) | Health Plan OF Careoregon, Inc. | T1 | No | $0 | OR |
| 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 |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS Insurance Company | T1 | No | $5.00 | OK |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | No | $17.00 | AZ |
| Hamaspik Medicare Select (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $34.50 | NY |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS Choice | T1 | No | $51.60 | NY |
Show the next 30 plans
| Gold Heart & Diabetes (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T2 | No | $0 | FL |
| Gold Heart & Diabetes Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T2 | No | $0 | FL |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T2 | No | $0 | FL |
| Gold Health (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T2 | No | $0 | FL |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T2 | No | $0 | FL |
| Gold Heart & Diabetes (HMO-POS C-SNP) | Gold Kidney OF Arizona | T2 | No | $0 | AZ |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | Gold Kidney OF Arizona | T2 | No | $0 | AZ |
| Gold Heart & Diabetes (HMO-POS C-SNP) | Gold Kidney OF Arizona | T2 | No | $0 | AZ |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | Gold Kidney OF Arizona | T2 | No | $0 | AZ |
| Security Blue HMO-POS Standard (HMO-POS) | Highmark Choice Company | T2 | No | $51.80 | PA |
| Freedom Blue PPO Select (PPO) | Highmark Senior Health Company | T2 | No | $95.70 | PA |
| Security Blue HMO-POS Deluxe (HMO-POS) | Highmark Choice Company | T2 | No | $95.90 | PA |
| Freedom Blue PPO Standard (PPO) | Highmark Senior Health Company | T2 | No | $98.20 | PA |
| Freedom Blue PPO Select (PPO) | Highmark Senior Health Company | T2 | No | $115.70 | PA |
| Freedom Blue PPO Deluxe (PPO) | Highmark Senior Health Company | T2 | No | $122.40 | PA |
| Freedom Blue PPO Classic (PPO) | Highmark Senior Health Company | T2 | No | $140.90 | PA |
| Freedom Blue PPO Classic (PPO) | Highmark Senior Health Company | T2 | No | $145.40 | PA |
| UHC Dual Complete IA-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T3 | No | $0 | IA |
| UHC Dual Complete MO-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T3 | No | $0 | MO |
| UHC Dual Complete NE-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T3 | No | $0 | NE |
| UHC Dual Complete KS-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T3 | No | $0 | KS |
| UHC Dual Complete MO-S3 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T3 | No | $0 | MO |
| UHC Dual Complete KS-Q1 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T3 | No | $0 | KS |
| UHC Dual Complete TN-S001 (HMO-POS D-SNP) | Unitedhealthcare Plan OF THE River Valley, Inc. | T3 | No | $0 | TN |
| UHC Dual Complete TN-Y001 (HMO-POS D-SNP) | Unitedhealthcare Plan OF THE River Valley, Inc. | T3 | No | $0 | TN |
| UHC Dual Complete TN-Y2 (HMO-POS D-SNP) | Unitedhealthcare Plan OF THE River Valley, Inc. | T3 | No | $0 | TN |
| AARP Medicare Advantage from UHC MI-0001 (PPO) | Unitedhealthcare Insurance Company | T3 | No | $0 | MI |
| UHC Dual Complete NM-Y1 (PPO D-SNP) | Unitedhealthcare Insurance Company | T3 | No | $0 | NM |
| UHC Dual Complete NM-S1 (PPO D-SNP) | Unitedhealthcare Insurance Company | T3 | No | $0 | NM |
| UHC Dual Complete NM-V1 (PPO D-SNP) | Unitedhealthcare Insurance Company | T3 | No | $0 | NM |
Showing top 50 of 96 plans.
Frequently Asked Questions
Is cephalexin 750 MG Oral Capsule covered by Medicare Part D?
Yes, cephalexin 750 MG Oral Capsule is covered by 1,682 Medicare Part D plans (33.3% of all Part D formularies).
What tier is cephalexin 750 MG Oral Capsule on Medicare Part D plans?
cephalexin 750 MG Oral Capsule averages Tier 3 across Part D plans, ranging from Tier 1 to Tier 4.
Does cephalexin 750 MG Oral Capsule require prior authorization?
0% of Part D formularies require prior authorization for cephalexin 750 MG Oral Capsule. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on cephalexin 750 MG Oral Capsule?
In 2023, total Medicare Part D spending on cephalexin 750 MG Oral Capsule was $64,269,317, covering 5,051,787 beneficiaries. The average spend per beneficiary was $12.72.
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
Similar prior-authorization rate
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