cyclosporine 100 MG Oral Capsule [Sandimmune]
cyclosporine
RxCUI: 197552
What the CMS Formulary Data Shows for cyclosporine 100 MG Oral Capsule [Sandimmune]
Per the CMS 2026 Part D formulary file, cyclosporine 100 MG Oral Capsule [Sandimmune] (RxNorm concept RXCUI 197552, generic name cyclosporine) appears on 7 distinct formulary files spanning 104 Medicare Part D plan offerings - 2.1% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 3.6.
Real-world access to cyclosporine 100 MG Oral Capsule [Sandimmune] depends on utilization management as much as tier placement: 100% 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 492,479 Part D beneficiaries filled cyclosporine 100 MG Oral Capsule [Sandimmune] in 2023, with total plan-and-beneficiary spending of $1,501,664,198 and an average per-beneficiary annual cost of $3,049.19. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry cyclosporine 100 MG Oral Capsule [Sandimmune] today.
Coverage Details
- Formularies covering
- 7
- Plans covering
- 104
- Coverage rate
- 2.1%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 492,479
- Total spending
- $1,501,664,198
- Avg per beneficiary
- $3,049.19
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering cyclosporine 100 MG Oral Capsule [Sandimmune]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $0 | NY |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T1 | Yes | $0 | CA |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $34.50 | NY |
| Óptimo Plus (PPO) | TRIPLE S ADVANTAGE, INC. | T4 | Yes | $0 | PR |
| Contigo Plus (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T4 | Yes | $0 | PR |
| Brillante (HMO-POS) | TRIPLE S ADVANTAGE, INC. | T4 | Yes | $0 | PR |
| Enlace Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T4 | Yes | $0 | PR |
| ContigoEnMente (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T4 | Yes | $0 | PR |
| Ahorro Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T4 | Yes | $0 | PR |
| SCAN Connections (HMO D-SNP) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Connections at Home (HMO D-SNP) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN NEVADA, INC. | T4 | Yes | $0 | NV |
| SCAN Balance (HMO C-SNP) | SCAN HEALTH PLAN NEVADA, INC. | T4 | Yes | $0 | NV |
| SCAN Strive (HMO C-SNP) | SCAN HEALTH PLAN NEVADA, INC. | T4 | Yes | $0 | NV |
| SCAN MyChoice (HMO) | SCAN HEALTH PLAN NEVADA, INC. | T4 | Yes | $0 | NV |
| SCAN Classic (HMO) | SCAN DESERT HEALTH PLAN, INC. | T4 | Yes | $0 | AZ |
| SCAN Balance (HMO C-SNP) | SCAN DESERT HEALTH PLAN, INC. | T4 | Yes | $0 | AZ |
| SCAN Embrace (HMO-POS I-SNP) | SCAN DESERT HEALTH PLAN, INC. | T4 | Yes | $0 | AZ |
| SCAN Strive (HMO C-SNP) | SCAN DESERT HEALTH PLAN, INC. | T4 | Yes | $0 | AZ |
| SCAN MyChoice (HMO) | SCAN DESERT HEALTH PLAN, INC. | T4 | Yes | $0 | AZ |
| SCAN Classic WA (HMO) | SCAN HEALTH PLAN (WA) | T4 | Yes | $0 | WA |
| SCAN MyChoice WA (HMO) | SCAN HEALTH PLAN (WA) | T4 | Yes | $0 | WA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN (NM) | T4 | Yes | $0 | NM |
| SCAN Balance (HMO C-SNP) | SCAN HEALTH PLAN (NM) | T4 | Yes | $0 | NM |
| SCAN Strive (HMO C-SNP) | SCAN HEALTH PLAN (NM) | T4 | Yes | $0 | NM |
| SCAN MyChoice (HMO) | SCAN HEALTH PLAN (NM) | T4 | Yes | $0 | NM |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Balance (HMO C-SNP) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Prime (HMO) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Balance (HMO C-SNP) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Balance (HMO C-SNP) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Alta (HMO) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Venture (HMO) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Venture (HMO) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Embrace (HMO I-SNP) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Embrace (HMO I-SNP) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Embrace (HMO-POS I-SNP) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Affirm partnered with Included LGBTQ+ Health (HMO) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Affirm partnered with Included LGBTQ+ Health (HMO) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Strive (HMO C-SNP) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Strive (HMO C-SNP) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
| SCAN Inspired by women for women (HMO) | SCAN HEALTH PLAN | T4 | Yes | $0 | CA |
Frequently Asked Questions
Is cyclosporine 100 MG Oral Capsule [Sandimmune] covered by Medicare Part D?
Yes, cyclosporine 100 MG Oral Capsule [Sandimmune] is covered by 104 Medicare Part D plans (2.1% of all Part D formularies).
What tier is cyclosporine 100 MG Oral Capsule [Sandimmune] on Medicare Part D plans?
cyclosporine 100 MG Oral Capsule [Sandimmune] averages Tier 3.6 across Part D plans, ranging from Tier 1 to Tier 5.
Does cyclosporine 100 MG Oral Capsule [Sandimmune] require prior authorization?
100% of Part D formularies require prior authorization for cyclosporine 100 MG Oral Capsule [Sandimmune]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on cyclosporine 100 MG Oral Capsule [Sandimmune]?
In 2023, total Medicare Part D spending on cyclosporine 100 MG Oral Capsule [Sandimmune] was $1,501,664,198, covering 492,479 beneficiaries. The average spend per beneficiary was $3,049.19.
Read our methodology - how this data is sourced, computed, and verified.