Medicare Part D coverage · cyproheptadine hydrochloride · RxCUI 866144
cyproheptadine hydrochloride 4 MG Oral Tablet
Per the CMS 2026 Part D formulary file, cyproheptadine hydrochloride 4 MG Oral Tablet is covered by 2,869 Medicare Part D plans (56.8% of enrollable products), averaging Tier 2.6, with prior authorization required on 58.5% of covering formularies.
- 56.8%
- Plan coverage
- 2,869
- Plans covering
- T2.6
- Avg tier
- 58.5%
- Prior auth required
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 234 distinct formulary files spanning 2,869 Medicare Part D plan offerings - 56.8% 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: 58.5% 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 $6,463,850 and an average per-beneficiary annual cost of $97.22. 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
- 234
- Plans covering
- 2,869
- Coverage rate
- 56.8%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 58.5% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 1.7% of formularies
2023 Medicare Spending
- Beneficiaries
- 66,484
- Total spending
- $6,463,850
- Avg per beneficiary
- $97.22
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 |
Show the next 30 plans
| 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 |
Showing top 50 of 100 plans.
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 2,869 Medicare Part D plans (56.8% 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?
58.5% 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 $6,463,850, covering 66,484 beneficiaries. The average spend per beneficiary was $97.22.
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
- 500 ML glucose 50 MG/ML / sodium chloride 4.5 MG/ML Injection T2.6
- amoxapine 100 MG Oral Tablet T2.6
- fluorouracil 50 MG/ML Topical Cream T2.6
- 1000 ML glucose 100 MG/ML / sodium chloride 4.5 MG/ML Injection T2.6
- hydrochlorothiazide 12.5 MG / quinapril 10 MG Oral Tablet T2.6
- desonide 0.0005 MG/MG Topical Ointment T2.6
Similar prior-authorization rate
- carisoprodol 350 MG Oral Tablet 58.3% PA
- Timothy grass pollen extract 2800 BAU Sublingual Tablet [Grastek] 58.3% PA
- Abuse-Deterrent 12 HR oxycodone hydrochloride 10 MG Extended Release Oral Tablet [Oxycontin] 58.8% PA
- Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin] 58.8% PA
- Abuse-Deterrent 12 HR oxycodone hydrochloride 80 MG Extended Release Oral Tablet [Oxycontin] 58.8% PA
- acetaminophen 325 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule 58.2% PA