Medicare Part D coverage · dextroamphetamine sulfate · RxCUI 884684
dextroamphetamine sulfate 15 MG Oral Tablet
Per the CMS 2026 Part D formulary file, dextroamphetamine sulfate 15 MG Oral Tablet is covered by 2,140 Medicare Part D plans (42.4% of enrollable products), averaging Tier 2.9, with prior authorization required on 0% of covering formularies.
- 42.4%
- Plan coverage
- 2,140
- Plans covering
- T2.9
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for dextroamphetamine sulfate 15 MG Oral Tablet
Per the CMS 2026 Part D formulary file, dextroamphetamine sulfate 15 MG Oral Tablet (RxNorm concept RXCUI 884684, generic name dextroamphetamine sulfate) appears on 48 distinct formulary files spanning 2,140 Medicare Part D plan offerings - 42.4% 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 2.9.
Real-world access to dextroamphetamine sulfate 15 MG Oral Tablet depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 72.9% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 9,950 Part D beneficiaries filled dextroamphetamine sulfate 15 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $5,176,356 and an average per-beneficiary annual cost of $520.24. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry dextroamphetamine sulfate 15 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 48
- Plans covering
- 2,140
- Coverage rate
- 42.4%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 72.9% of formularies
2023 Medicare Spending
- Beneficiaries
- 9,950
- Total spending
- $5,176,356
- Avg per beneficiary
- $520.24
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering dextroamphetamine sulfate 15 MG Oral Tablet
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T1 | No | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T1 | No | $0 | NY |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | No | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | No | $17.00 | AZ |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS Choice | T1 | No | $51.60 | NY |
| Network Health Select (PPO) | Network Health Insurance Corporation | T2 | No | $0 | WI |
| Network Health Go (PPO) | Network Health Insurance Corporation | T2 | No | $0 | WI |
| Network Health Anywhere (PPO) | Network Health Insurance Corporation | T2 | No | $0 | WI |
| Network Health Choice (PPO) | Network Health Insurance Corporation | T2 | No | $0 | WI |
| Network Health Zero (PPO) | Network Health Insurance Corporation | T2 | No | $0 | WI |
| DrMax (HMO) | Doctors Healthcare Plans, Inc. | T2 | No | $0 | FL |
| DrExtraCare (HMO C-SNP) | Doctors Healthcare Plans, Inc. | T2 | No | $0 | FL |
Show the next 30 plans
| DrSelect (HMO) | Doctors Healthcare Plans, Inc. | T2 | No | $0 | FL |
| DrSelect-CFL (HMO) | Doctors Healthcare Plans, Inc. | T2 | No | $0 | FL |
| DrPlatinum-CFL (HMO D-SNP) | Doctors Healthcare Plans, Inc. | T2 | No | $0 | FL |
| DrTotalCare-CFL (HMO C-SNP) | Doctors Healthcare Plans, Inc. | T2 | No | $0 | FL |
| DrElite-SFL (HMO) | Doctors Healthcare Plans, Inc. | T2 | No | $0 | FL |
| MCS Classicare RxMax (HMO) | MCS Advantage, Inc. | T2 | No | $0 | PR |
| MCS Classicare Platino Ideal (HMO D-SNP) | MCS Advantage, Inc. | T2 | No | $0 | PR |
| MCS Classicare Efectivo (HMO) | MCS Advantage, Inc. | T2 | No | $0 | PR |
| MCS Classicare Essential (HMO-POS) | MCS Advantage, Inc. | T2 | No | $0 | PR |
| MCS Classicare Platino Progreso (HMO D-SNP) | MCS Advantage, Inc. | T2 | No | $0 | PR |
| MCS Classicare Primero (HMO C-SNP) | MCS Advantage, Inc. | T2 | No | $0 | PR |
| MCS Classicare Firme (HMO) | MCS Advantage, Inc. | T2 | No | $0 | PR |
| MCS Classicare En Tu Hogar (HMO) | MCS Advantage, Inc. | T2 | No | $0 | PR |
| MCS Classicare Hero (HMO) | MCS Advantage, Inc. | T2 | No | $0 | PR |
| MCS Classicare Platino Total (HMO D-SNP) | MCS Advantage, Inc. | T2 | No | $0 | PR |
| MCS Classicare InteliCare (HMO) | MCS Advantage, Inc. | T2 | No | $0 | PR |
| MCS Classicare Platino Maximo (HMO D-SNP) | MCS Advantage, Inc. | T2 | No | $0 | PR |
| MCS Classicare Excede (HMO) | MCS Advantage, Inc. | T2 | No | $0 | PR |
| MCS Classicare Estrella (HMO) | MCS Advantage, Inc. | T2 | No | $0 | PR |
| MCS Classicare Platino Superior (HMO D-SNP) | MCS Advantage, Inc. | T2 | No | $0 | PR |
| MCS Classicare Platino 185 (HMO D-SNP) | MCS Advantage, Inc. | T2 | No | $0 | PR |
| Fallon Medicare Plus Orange (HMO) | Fallon Community Health Plan | T2 | No | $0 | MA |
| Healthy Mississippi Premier Advantage (HMO-POS) | Healthy Mississippi, Inc. | T2 | No | $0 | MS |
| Wellcare Superior HealthPlan Dual Align (HMO D-SNP) | Superior Healthplan, Inc. | T2 | No | $0 | TX |
| Wellcare Superior HealthPlan Dual Align (HMO D-SNP) | Superior Healthplan, Inc. | T2 | No | $0 | TX |
| Wellcare Dual Access Open (PPO D-SNP) | Wellcare OF Mississippi, Inc. | T2 | No | $0 | MS |
| Wellcare Dual Access Open (PPO D-SNP) | Wellcare OF Georgia, Inc. | T2 | No | $0 | GA |
| Wellcare Dual Liberty Sync (HMO D-SNP) | Wellcare OF Texas, Inc. | T2 | No | $0 | TX |
| Wellcare Dual Liberty Sync (HMO D-SNP) | Wellcare OF Texas, Inc. | T2 | No | $0 | TX |
| Wellcare Dual Liberty (HMO D-SNP) | Wellcare OF Connecticut, Inc. | T2 | No | $0 | CT |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is dextroamphetamine sulfate 15 MG Oral Tablet covered by Medicare Part D?
Yes, dextroamphetamine sulfate 15 MG Oral Tablet is covered by 2,140 Medicare Part D plans (42.4% of all Part D formularies).
What tier is dextroamphetamine sulfate 15 MG Oral Tablet on Medicare Part D plans?
dextroamphetamine sulfate 15 MG Oral Tablet averages Tier 2.9 across Part D plans, ranging from Tier 1 to Tier 4.
Does dextroamphetamine sulfate 15 MG Oral Tablet require prior authorization?
0% of Part D formularies require prior authorization for dextroamphetamine sulfate 15 MG Oral Tablet. Step therapy: 0%. Quantity limits: 72.9%.
How much does Medicare spend on dextroamphetamine sulfate 15 MG Oral Tablet?
In 2023, total Medicare Part D spending on dextroamphetamine sulfate 15 MG Oral Tablet was $5,176,356, covering 9,950 beneficiaries. The average spend per beneficiary was $520.24.
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
Similar prior-authorization rate
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