Medicare Part D coverage · cyproheptadine hydrochloride · RxCUI 866021
cyproheptadine hydrochloride 0.4 MG/ML Oral Solution
Per the CMS 2026 Part D formulary file, cyproheptadine hydrochloride 0.4 MG/ML Oral Solution is covered by 2,008 Medicare Part D plans (39.7% of enrollable products), averaging Tier 2.1, with prior authorization required on 60.7% of covering formularies.
- 39.7%
- Plan coverage
- 2,008
- Plans covering
- T2.1
- Avg tier
- 60.7%
- Prior auth required
What the CMS Formulary Data Shows for cyproheptadine hydrochloride 0.4 MG/ML Oral Solution
Per the CMS 2026 Part D formulary file, cyproheptadine hydrochloride 0.4 MG/ML Oral Solution (RxNorm concept RXCUI 866021, generic name cyproheptadine hydrochloride) appears on 150 distinct formulary files spanning 2,008 Medicare Part D plan offerings - 39.7% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.1.
Real-world access to cyproheptadine hydrochloride 0.4 MG/ML Oral Solution depends on utilization management as much as tier placement: 60.7% of covering formularies require prior authorization. 0% require step therapy. 2% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 66,484 Part D beneficiaries filled cyproheptadine hydrochloride 0.4 MG/ML Oral Solution 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 0.4 MG/ML Oral Solution today.
Coverage Details
- Formularies covering
- 150
- Plans covering
- 2,008
- Coverage rate
- 39.7%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 60.7% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 2% 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 0.4 MG/ML Oral Solution
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun MediMax (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun MediSun Plus (HMO D-SNP) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun MediSun Extra (HMO D-SNP) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun MediSun Full Dual Plus (HMO D-SNP) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun MediSun Full Dual Extra (HMO D-SNP) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
Show the next 30 plans
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Extra (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply More Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Complete Platinum (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply More Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Complete Platinum (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Integrated Platinum (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Integrated Platinum (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is cyproheptadine hydrochloride 0.4 MG/ML Oral Solution covered by Medicare Part D?
Yes, cyproheptadine hydrochloride 0.4 MG/ML Oral Solution is covered by 2,008 Medicare Part D plans (39.7% of all Part D formularies).
What tier is cyproheptadine hydrochloride 0.4 MG/ML Oral Solution on Medicare Part D plans?
cyproheptadine hydrochloride 0.4 MG/ML Oral Solution averages Tier 2.1 across Part D plans, ranging from Tier 1 to Tier 4.
Does cyproheptadine hydrochloride 0.4 MG/ML Oral Solution require prior authorization?
60.7% of Part D formularies require prior authorization for cyproheptadine hydrochloride 0.4 MG/ML Oral Solution. Step therapy: 0%. Quantity limits: 2%.
How much does Medicare spend on cyproheptadine hydrochloride 0.4 MG/ML Oral Solution?
In 2023, total Medicare Part D spending on cyproheptadine hydrochloride 0.4 MG/ML Oral Solution 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
- 1 ML medroxyprogesterone acetate 150 MG/ML Injection T2.1
- bethanechol chloride 50 MG Oral Tablet T2.1
- betamethasone 0.001 MG/MG Topical Ointment T2.1
- amantadine hydrochloride 100 MG Oral Capsule T2.1
- carbidopa 25 MG / levodopa 100 MG Extended Release Oral Tablet T2.1
- testosterone cypionate 200 MG/ML Injectable Solution T2.1
Similar prior-authorization rate
- iloperidone 10 MG Oral Tablet [Fanapt] 60.7% PA
- iloperidone 2 MG Oral Tablet [Fanapt] 60.7% PA
- iloperidone 1 MG Oral Tablet [Fanapt] 60.7% PA
- 24 HR budesonide 9 MG Extended Release Oral Tablet 60.7% PA
- {2 (iloperidone 1 MG Oral Tablet [Fanapt]) / 2 (iloperidone 2 MG Oral Tablet [Fanapt]) / 2 (iloperidone 4 MG Oral Tablet [Fanapt]) / 2 (iloperidone 6 MG Oral Tablet [Fanapt]) } Pack [Fanapt Titration Pack] 60.7% PA
- aspirin 325 MG / butalbital 50 MG / caffeine 40 MG / codeine phosphate 30 MG Oral Capsule 60.7% PA