Medicare Part D coverage · cysteamine · RxCUI 2396905
cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops]
Per the CMS 2026 Part D formulary file, cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops] is covered by 802 Medicare Part D plans (15.9% of enrollable products), averaging Tier 3.9, with prior authorization required on 97% of covering formularies.
- 15.9%
- Plan coverage
- 802
- Plans covering
- T3.9
- Avg tier
- 97%
- Prior auth required
What the CMS Formulary Data Shows for cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops]
Per the CMS 2026 Part D formulary file, cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops] (RxNorm concept RXCUI 2396905, generic name cysteamine) appears on 99 distinct formulary files spanning 802 Medicare Part D plan offerings - 15.9% 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 3.9.
Real-world access to cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops] depends on utilization management as much as tier placement: 97% of covering formularies require prior authorization. 0% require step therapy. 34.3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 30 Part D beneficiaries filled cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops] in 2023, with total plan-and-beneficiary spending of $2,301,078 and an average per-beneficiary annual cost of $76,702.62. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops] today.
Coverage Details
- Formularies covering
- 99
- Plans covering
- 802
- Coverage rate
- 15.9%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 97% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 34.3% of formularies
2023 Medicare Spending
- Beneficiaries
- 30
- Total spending
- $2,301,078
- Avg per beneficiary
- $76,702.62
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | Yes | $0 | NY |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | Yes | $0 | AL |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
Show the next 30 plans
| Florida Complete Care (HMO I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | Yes | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | American Health Plan OF FL, Inc. | T1 | Yes | $4.80 | FL |
| SECUR Advantage (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| SECUR Enhanced (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| Senior Care (HMO I-SNP) | Align Senior Care MI, LLC | T1 | Yes | $8.80 | MI |
| AgeRight Advantage Health Plan (HMO I-SNP) | Marquis Advantage, Inc. | T1 | Yes | $10.50 | OR, WA |
| Senior Care (HMO I-SNP) | Align Senior Care California Inc. | T1 | Yes | $12.00 | CA |
| Liberty Medicare Dual Plan (HMO D-SNP) | Liberty Advantage, LLC | T1 | Yes | $14.70 | NC |
| Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $22.70 | NY |
| KeyCare Advantage (HMO I-SNP) | Isnp Ventures, LLC | T1 | Yes | $23.20 | MD |
| American Health Advantage of Mississippi (HMO I-SNP) | American Health Plan OF MS, Inc. | T1 | Yes | $23.80 | MS |
| Senior Care (HMO I-SNP) | Lifeworks Advantage, LLC | T1 | Yes | $24.60 | VA |
| PruittHealth Premier (HMO I-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $25.40 | GA |
| Georgia Health Advantage (HMO I-SNP) | Georgia Assurance, Inc. | T1 | Yes | $25.40 | GA |
| Georgia Health Advantage Choice (HMO I-SNP) | Georgia Assurance, Inc. | T1 | Yes | $25.40 | GA |
| VIVA Medicare Extra Value (HMO D-SNP) | Viva Health, Inc. | T1 | Yes | $27.70 | AL |
| VIVA Medicare Extra Care (HMO D-SNP) | Viva Health, Inc. | T1 | Yes | $27.70 | AL |
| American Health Advantage of Tennessee (HMO I-SNP) | American Health Plan, Inc. | T1 | Yes | $27.70 | TN |
| Simpra Advantage Nursing Home Plan (PPO I-SNP) | Simpra Advantage, Inc. | T1 | Yes | $27.70 | AL |
| American Health Advantage of Oklahoma (HMO I-SNP) | Oklahoma Superior Select, Inc. | T1 | Yes | $28.20 | OK |
| NHC Advantage (HMO I-SNP) | NHC Advantage, LLC | T1 | Yes | $31.00 | MO, NC, SC, TN |
| Perennial Advantage Strive (HMO I-SNP) | Perennial Advantage OF Ohio, Inc. | T1 | Yes | $31.40 | OH |
| Perennial Advantage Strive (HMO I-SNP) | Perennial Advantage OF Colorado, Inc. | T1 | Yes | $32.70 | PA |
| American Health Advantage of Pennsylvania (HMO I-SNP) | American Health Plan OF Pennsylvania Inc | T1 | Yes | $32.70 | PA |
| Lagniappe Advantage (PPO I-SNP) | Lagniappe Advantage Insurance Company | T1 | Yes | $32.90 | LA |
| American Health Advantage of Louisiana (HMO I-SNP) | Dignity Care Corporation | T1 | Yes | $32.90 | LA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops] covered by Medicare Part D?
Yes, cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops] is covered by 802 Medicare Part D plans (15.9% of all Part D formularies).
What tier is cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops] on Medicare Part D plans?
cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops] averages Tier 3.9 across Part D plans, ranging from Tier 1 to Tier 5.
Does cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops] require prior authorization?
97% of Part D formularies require prior authorization for cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops]. Step therapy: 0%. Quantity limits: 34.3%.
How much does Medicare spend on cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops]?
In 2023, total Medicare Part D spending on cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops] was $2,301,078, covering 30 beneficiaries. The average spend per beneficiary was $76,702.62.
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
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- crinecerfont 25 MG Oral Capsule [Crenessity] T3.9
- {180 (danicopan 100 MG Oral Tablet [Voydeya]) } Pack [Voydeya 200 MG Dose Bottle] T3.9
- {90 (danicopan 100 MG Oral Tablet [Voydeya]) / 90 (danicopan 50 MG Oral Tablet [Voydeya]) } Pack [Voydeya 150 MG Dose Bottle] T3.9
Similar prior-authorization rate
- sparsentan 400 MG Oral Tablet [Filspari] 97% PA
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- treprostinil 0.0265 MG Inhalation Powder [Yutrepia] 97% PA
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