cyproheptadine hydrochloride 4 MG Oral Tablet
cyproheptadine hydrochloride
RxCUI: 866144
What the CMS Formulary Data Shows for cyproheptadine hydrochloride 4 MG Oral Tablet
Per the CMS 2026 Part D formulary file, cyproheptadine hydrochloride 4 MG Oral Tablet (RxNorm concept RXCUI 866144, generic name cyproheptadine hydrochloride) appears on 235 distinct formulary files spanning 2,883 Medicare Part D plan offerings - 56.9% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.6.
Real-world access to cyproheptadine hydrochloride 4 MG Oral Tablet depends on utilization management as much as tier placement: 58.3% of covering formularies require prior authorization. 0% require step therapy. 1.7% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 66,484 Part D beneficiaries filled cyproheptadine hydrochloride 4 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $6,467,230 and an average per-beneficiary annual cost of $97.27. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry cyproheptadine hydrochloride 4 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 235
- Plans covering
- 2,883
- Coverage rate
- 56.9%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 58.3% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 1.7% of formularies
2023 Medicare Spending
- Beneficiaries
- 66,484
- Total spending
- $6,467,230
- Avg per beneficiary
- $97.27
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering cyproheptadine hydrochloride 4 MG Oral Tablet
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | SENTARA HEALTH PLANS | T1 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | SENTARA HEALTH PLANS | T1 | No | $0 | VA |
| Freedom VIP Care (HMO C-SNP) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | No | $0 | FL |
| Optimum Diamond Savings (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | No | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | No | $0 | FL |
| Optimum Diamond (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | No | $0 | FL |
| Freedom Medi-Medi Partial (HMO D-SNP) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom Medi-Medi Full (HMO D-SNP) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Optimum Emerald Partial (HMO D-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | No | $0 | FL |
| Optimum Emerald Full (HMO D-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | No | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom Máximo (HMO-POS) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Freedom Máximo (HMO-POS) | FREEDOM HEALTH, INC. | T1 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T1 | No | $0 | FL |
| Optimum Platinum Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T1 | No | $0 | FL |
| Optimum Gold Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T1 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T1 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T1 | No | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | No | $0 | FL |
| Optimum Diamond Savings COPD (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | No | $0 | FL |
| Optimum Gold Plus Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T1 | No | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | No | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun MediMax (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun MediSun Plus (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun MediSun Extra (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
Frequently Asked Questions
Is cyproheptadine hydrochloride 4 MG Oral Tablet covered by Medicare Part D?
Yes, cyproheptadine hydrochloride 4 MG Oral Tablet is covered by 2,883 Medicare Part D plans (56.9% of all Part D formularies).
What tier is cyproheptadine hydrochloride 4 MG Oral Tablet on Medicare Part D plans?
cyproheptadine hydrochloride 4 MG Oral Tablet averages Tier 2.6 across Part D plans, ranging from Tier 1 to Tier 4.
Does cyproheptadine hydrochloride 4 MG Oral Tablet require prior authorization?
58.3% of Part D formularies require prior authorization for cyproheptadine hydrochloride 4 MG Oral Tablet. Step therapy: 0%. Quantity limits: 1.7%.
How much does Medicare spend on cyproheptadine hydrochloride 4 MG Oral Tablet?
In 2023, total Medicare Part D spending on cyproheptadine hydrochloride 4 MG Oral Tablet was $6,467,230, covering 66,484 beneficiaries. The average spend per beneficiary was $97.27.
Read our methodology - how this data is sourced, computed, and verified.