crofelemer 125 MG Delayed Release Oral Tablet [Mytesi]
crofelemer
RxCUI: 1806878
What the CMS Formulary Data Shows for crofelemer 125 MG Delayed Release Oral Tablet [Mytesi]
Per the CMS 2026 Part D formulary file, crofelemer 125 MG Delayed Release Oral Tablet [Mytesi] (RxNorm concept RXCUI 1806878, generic name crofelemer) appears on 13 distinct formulary files spanning 148 Medicare Part D plan offerings - 2.9% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 2 to Tier 5, with a cross-plan average of Tier 4.3.
Real-world access to crofelemer 125 MG Delayed Release Oral Tablet [Mytesi] depends on utilization management as much as tier placement: 61.5% of covering formularies require prior authorization. 0% require step therapy. 23.1% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 379 Part D beneficiaries filled crofelemer 125 MG Delayed Release Oral Tablet [Mytesi] in 2023, with total plan-and-beneficiary spending of $7,449,992 and an average per-beneficiary annual cost of $19,656.97. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry crofelemer 125 MG Delayed Release Oral Tablet [Mytesi] today.
Coverage Details
- Formularies covering
- 13
- Plans covering
- 148
- Coverage rate
- 2.9%
- Tier range
- Tier 2 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 61.5% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 23.1% of formularies
2023 Medicare Spending
- Beneficiaries
- 379
- Total spending
- $7,449,992
- Avg per beneficiary
- $19,656.97
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering crofelemer 125 MG Delayed Release Oral Tablet [Mytesi]
100 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 |
| Freedom VIP Care (HMO C-SNP) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T4 | No | $0 | FL |
| Optimum Diamond Savings (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T4 | No | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T4 | No | $0 | FL |
| Optimum Diamond (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T4 | No | $0 | FL |
| Freedom Medi-Medi Partial (HMO D-SNP) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom Medi-Medi Full (HMO D-SNP) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Optimum Emerald Partial (HMO D-SNP) | OPTIMUM HEALTHCARE, INC. | T4 | No | $0 | FL |
| Optimum Emerald Full (HMO D-SNP) | OPTIMUM HEALTHCARE, INC. | T4 | No | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom Máximo (HMO-POS) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Freedom Máximo (HMO-POS) | FREEDOM HEALTH, INC. | T4 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T4 | No | $0 | FL |
| Optimum Platinum Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T4 | No | $0 | FL |
| Optimum Gold Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T4 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T4 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T4 | No | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T4 | No | $0 | FL |
| Optimum Diamond Savings COPD (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T4 | No | $0 | FL |
| Optimum Gold Plus Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T4 | No | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T4 | No | $0 | FL |
| Medicare BlueEssential (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $0 | NY |
| Medicare BlueActive (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $0 | NY |
| Medicare BlueVital (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $0 | NY |
| Univera SeniorChoice Basic (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $0 | NY |
| Univera SeniorChoice Extra (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $0 | NY |
| Medicare Blue Choice Core (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $0 | NY |
| Univera Medicare Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T4 | Yes | $0 | NY |
| Medicare Blue Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T4 | Yes | $0 | NY |
| CDPHP $0 Medicare Rx (HMO) | CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | T4 | Yes | $0 | NY |
| Univera SeniorChoice Core (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $33.00 | NY |
Frequently Asked Questions
Is crofelemer 125 MG Delayed Release Oral Tablet [Mytesi] covered by Medicare Part D?
Yes, crofelemer 125 MG Delayed Release Oral Tablet [Mytesi] is covered by 148 Medicare Part D plans (2.9% of all Part D formularies).
What tier is crofelemer 125 MG Delayed Release Oral Tablet [Mytesi] on Medicare Part D plans?
crofelemer 125 MG Delayed Release Oral Tablet [Mytesi] averages Tier 4.3 across Part D plans, ranging from Tier 2 to Tier 5.
Does crofelemer 125 MG Delayed Release Oral Tablet [Mytesi] require prior authorization?
61.5% of Part D formularies require prior authorization for crofelemer 125 MG Delayed Release Oral Tablet [Mytesi]. Step therapy: 0%. Quantity limits: 23.1%.
How much does Medicare spend on crofelemer 125 MG Delayed Release Oral Tablet [Mytesi]?
In 2023, total Medicare Part D spending on crofelemer 125 MG Delayed Release Oral Tablet [Mytesi] was $7,449,992, covering 379 beneficiaries. The average spend per beneficiary was $19,656.97.
Read our methodology - how this data is sourced, computed, and verified.