cephalexin 500 MG Oral Capsule
cephalexin
RxCUI: 309114
What the CMS Formulary Data Shows for cephalexin 500 MG Oral Capsule
Per the CMS 2026 Part D formulary file, cephalexin 500 MG Oral Capsule (RxNorm concept RXCUI 309114, generic name cephalexin) appears on 330 distinct formulary files spanning 5,067 Medicare Part D plan offerings - 100% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 2, with a cross-plan average of Tier 1.4.
Real-world access to cephalexin 500 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 500 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 500 MG Oral Capsule today.
Coverage Details
- Formularies covering
- 330
- Plans covering
- 5,067
- Coverage rate
- 100%
- Tier range
- Tier 1 – Tier 2
- Average tier
- Tier 1, Preferred Generic
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 500 MG Oral Capsule
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T1 | No | No | $0 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T1 | No | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering cephalexin 500 MG Oral Capsule
98 Medicare Advantage plans with Part D drug coverage include this drug.
Frequently Asked Questions
Is cephalexin 500 MG Oral Capsule covered by Medicare Part D?
Yes, cephalexin 500 MG Oral Capsule is covered by 5,067 Medicare Part D plans (100% of all Part D formularies).
What tier is cephalexin 500 MG Oral Capsule on Medicare Part D plans?
cephalexin 500 MG Oral Capsule averages Tier 1.4 across Part D plans, ranging from Tier 1 to Tier 2.
Does cephalexin 500 MG Oral Capsule require prior authorization?
0% of Part D formularies require prior authorization for cephalexin 500 MG Oral Capsule. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on cephalexin 500 MG Oral Capsule?
In 2023, total Medicare Part D spending on cephalexin 500 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.