cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops]
cysteamine
RxCUI: 2396905
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 100 distinct formulary files spanning 804 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 4.
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. 35% 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
- 100
- Plans covering
- 804
- 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
- 35% 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 |
| 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 |
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 804 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 4 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: 35%.
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.