cysteamine 75 MG Delayed Release Oral Granules [Procysbi]
cysteamine
RxCUI: 2284516
What the CMS Formulary Data Shows for cysteamine 75 MG Delayed Release Oral Granules [Procysbi]
Per the CMS 2026 Part D formulary file, cysteamine 75 MG Delayed Release Oral Granules [Procysbi] (RxNorm concept RXCUI 2284516, generic name cysteamine) appears on 5 distinct formulary files spanning 39 Medicare Part D plan offerings - 0.8% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 5 to Tier 5, with a cross-plan average of Tier 5.
Real-world access to cysteamine 75 MG Delayed Release Oral Granules [Procysbi] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 30 Part D beneficiaries filled cysteamine 75 MG Delayed Release Oral Granules [Procysbi] 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 75 MG Delayed Release Oral Granules [Procysbi] today.
Coverage Details
- Formularies covering
- 5
- Plans covering
- 39
- Coverage rate
- 0.8%
- Tier range
- Tier 5, Specialty
- Average tier
- Tier 5, Specialty
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 30
- Total spending
- $2,301,078
- Avg per beneficiary
- $76,702.62
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering cysteamine 75 MG Delayed Release Oral Granules [Procysbi]
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP) | HM HEALTH INSURANCE COMPANY | T5 | Yes | No | $164.80 | - |
| Blue Rx PDP Plus (PDP) | HM HEALTH INSURANCE COMPANY | T5 | Yes | No | $193.20 | - |
Medicare Advantage Plans (MA-PD) Covering cysteamine 75 MG Delayed Release Oral Granules [Procysbi]
37 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Medicare BlueEssential (PPO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| Medicare BlueActive (PPO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| Medicare BlueVital (PPO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| Univera SeniorChoice Basic (HMO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| Univera SeniorChoice Extra (HMO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| Medicare Blue Choice Core (HMO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| Univera Medicare Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T5 | Yes | $0 | NY |
| Medicare Blue Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T5 | Yes | $0 | NY |
| CDPHP $0 Medicare Rx (HMO) | CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| UPMC for Life HMO Rx Choice (HMO) | UPMC HEALTH PLAN, INC. | T5 | Yes | $3.90 | OH, PA |
| UPMC for Life HMO Deductible Rx (HMO) | UPMC HEALTH PLAN, INC. | T5 | Yes | $18.10 | OH, PA |
| UPMC for Life PPO Rx Choice (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $25.00 | PA |
| Univera SeniorChoice Core (PPO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $33.00 | NY |
| UPMC for Life PPO High Deductible Rx (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $33.00 | PA |
| UPMC for Life HMO Rx (HMO) | UPMC HEALTH PLAN, INC. | T5 | Yes | $33.70 | OH, PA |
| Univera SeniorChoice Advanced (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $36.90 | NY |
| UPMC for Life PPO Rx Enhanced (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $42.70 | PA |
| Medicare BlueClassic (PPO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $51.00 | NY |
| Security Blue HMO-POS Standard (HMO-POS) | HIGHMARK CHOICE COMPANY | T5 | Yes | $51.80 | PA |
| Univera SeniorChoice Secure (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $54.90 | NY |
| Medicare BlueBalanced (PPO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $55.00 | NY |
| Medicare Blue Choice Prime (HMO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $55.00 | NY |
| Univera SeniorChoice Value Plus (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $58.60 | NY |
| Medicare BlueEnhanced (PPO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $70.30 | NY |
| Medicare BluePlus (PPO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $86.40 | NY |
| UPMC for Life HMO Rx Enhanced (HMO) | UPMC HEALTH PLAN, INC. | T5 | Yes | $93.40 | OH, PA |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $95.70 | PA |
| Security Blue HMO-POS Deluxe (HMO-POS) | HIGHMARK CHOICE COMPANY | T5 | Yes | $95.90 | PA |
| Freedom Blue PPO Standard (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $98.20 | PA |
| CDPHP Clear Rx (HMO) | CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | T5 | Yes | $100.00 | NY |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $115.70 | PA |
| Freedom Blue PPO Deluxe (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $122.40 | PA |
| CDPHP Choice Rx (HMO) | CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | T5 | Yes | $135.00 | NY |
| UPMC for Life PPO Rx Enhanced (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $140.00 | PA |
| Freedom Blue PPO Classic (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $140.90 | PA |
| Freedom Blue PPO Classic (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $145.40 | PA |
| Medicare Blue Choice Optimum (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $146.00 | NY |
Frequently Asked Questions
Is cysteamine 75 MG Delayed Release Oral Granules [Procysbi] covered by Medicare Part D?
Yes, cysteamine 75 MG Delayed Release Oral Granules [Procysbi] is covered by 39 Medicare Part D plans (0.8% of all Part D formularies).
What tier is cysteamine 75 MG Delayed Release Oral Granules [Procysbi] on Medicare Part D plans?
cysteamine 75 MG Delayed Release Oral Granules [Procysbi] averages Tier 5 across Part D plans, ranging from Tier 5 to Tier 5.
Does cysteamine 75 MG Delayed Release Oral Granules [Procysbi] require prior authorization?
100% of Part D formularies require prior authorization for cysteamine 75 MG Delayed Release Oral Granules [Procysbi]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on cysteamine 75 MG Delayed Release Oral Granules [Procysbi]?
In 2023, total Medicare Part D spending on cysteamine 75 MG Delayed Release Oral Granules [Procysbi] 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.