dextroamphetamine sulfate 1 MG/ML Oral Solution
dextroamphetamine sulfate
RxCUI: 884522
What the CMS Formulary Data Shows for dextroamphetamine sulfate 1 MG/ML Oral Solution
Per the CMS 2026 Part D formulary file, dextroamphetamine sulfate 1 MG/ML Oral Solution (RxNorm concept RXCUI 884522, generic name dextroamphetamine sulfate) appears on 16 distinct formulary files spanning 832 Medicare Part D plan offerings - 16.4% 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 3.8.
Real-world access to dextroamphetamine sulfate 1 MG/ML Oral Solution depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 68.8% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 9,950 Part D beneficiaries filled dextroamphetamine sulfate 1 MG/ML Oral Solution 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 1 MG/ML Oral Solution today.
Coverage Details
- Formularies covering
- 16
- Plans covering
- 832
- Coverage rate
- 16.4%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 68.8% 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 1 MG/ML Oral Solution
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Community Care's Partnership Program (HMO D-SNP) | COMMUNITY CARE HEALTH PLAN, INC. | T1 | No | $0 | WI |
| HAP Medicare Explore (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T2 | No | $0 | MI |
| HAP Medicare Prime (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T2 | No | $0 | MI |
| HAP Medicare Connect (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T2 | No | $0 | MI |
| HAP Medicare Complete Duals (HMO D-SNP) | HEALTH ALLIANCE PLAN OF MICHIGAN | T2 | No | $0 | MI |
| HAP Medicare Superior (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T2 | No | $0 | MI |
| Henry Ford Select (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T2 | No | $0 | MI |
| 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 |
| HAP Member Assist (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T2 | No | $8.80 | MI |
| HAP Medicare Complete Assist (PPO D-SNP) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T2 | No | $8.80 | MI |
| HAP Medicare Diabetes and Heart (HMO C-SNP) | HEALTH ALLIANCE PLAN OF MICHIGAN | T2 | No | $8.80 | MI |
| HAP Senior Plus Henry Ford Tiered Access (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T2 | No | $11.30 | MI |
| HAP Senior Plus (HMO-POS) | HEALTH ALLIANCE PLAN OF MICHIGAN | T2 | No | $13.50 | MI |
| Network Health Cares (PPO D-SNP) | NETWORK HEALTH INSURANCE CORPORATION | T2 | No | $21.10 | WI |
| Network Health PlusRx (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T2 | No | $38.60 | WI |
| HAP Senior Plus (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T2 | No | $42.60 | MI |
| Network Health PremierRx (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T2 | No | $92.80 | WI |
| Aetna Medicare Signature (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T4 | No | $0 | CA |
| Aetna Medicare Signature (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T4 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T4 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T4 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T4 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T4 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T4 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T4 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T4 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T4 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T4 | No | $0 | CA |
| Aetna Medicare Signature Care (HMO-POS) | AETNA HEALTH OF OHIO INC. | T4 | No | $0 | OH |
| Aetna Medicare Signature Extra (HMO-POS) | AETNA HEALTH OF OHIO INC. | T4 | No | $0 | OH |
| Aetna Medicare Signature Care (HMO-POS) | AETNA HEALTH OF OHIO INC. | T4 | No | $0 | OH |
| Aetna Medicare Signature Extra (HMO-POS) | AETNA HEALTH OF OHIO INC. | T4 | No | $0 | KY |
| Aetna Medicare Signature (HMO-POS) | AETNA HEALTH OF OHIO INC. | T4 | No | $0 | KY |
| Aetna Medicare Signature (HMO-POS) | AETNA HEALTH OF OHIO INC. | T4 | No | $0 | KY |
| Aetna Medicare HIDE (HMO D-SNP) | AETNA HEALTH OF OHIO INC. | T4 | No | $0 | KY |
| Aetna Medicare Dual Care (HMO D-SNP) | AETNA HEALTH OF OHIO INC. | T4 | No | $0 | OH |
| Aetna Medicare Signature Care (HMO-POS) | AETNA HEALTH OF OHIO INC. | T4 | No | $0 | OH |
| Aetna Medicare Signature (HMO-POS) | AETNA HEALTH OF OHIO INC. | T4 | No | $0 | OH |
| Aetna Medicare Signature (HMO-POS) | AETNA HEALTH OF OHIO INC. | T4 | No | $0 | KY |
| Aetna Medicare Partial Dual (HMO D-SNP) | AETNA HEALTH OF OHIO INC. | T4 | No | $0 | KY |
| Aetna Medicare Partial Dual (HMO D-SNP) | AETNA HEALTH OF OHIO INC. | T4 | No | $0 | OH |
| Aetna Medicare Signature (HMO) | AETNA HEALTH INC.(GA) | T4 | No | $0 | GA |
| Aetna Medicare Signature (HMO-POS) | COVENTRY HEALTH CARE OF ILLINOIS, INC. | T4 | No | $0 | WI |
| Aetna Medicare Signature (HMO-POS) | COVENTRY HEALTH CARE OF ILLINOIS, INC. | T4 | No | $0 | IL |
| Aetna Medicare Prime Chronic Care (HMO C-SNP) | COVENTRY HEALTH CARE OF ILLINOIS, INC. | T4 | No | $0 | IL |
| Aetna Medicare Signature Extra (HMO-POS) | COVENTRY HEALTH CARE OF ILLINOIS, INC. | T4 | No | $0 | IL |
Frequently Asked Questions
Is dextroamphetamine sulfate 1 MG/ML Oral Solution covered by Medicare Part D?
Yes, dextroamphetamine sulfate 1 MG/ML Oral Solution is covered by 832 Medicare Part D plans (16.4% of all Part D formularies).
What tier is dextroamphetamine sulfate 1 MG/ML Oral Solution on Medicare Part D plans?
dextroamphetamine sulfate 1 MG/ML Oral Solution averages Tier 3.8 across Part D plans, ranging from Tier 1 to Tier 5.
Does dextroamphetamine sulfate 1 MG/ML Oral Solution require prior authorization?
0% of Part D formularies require prior authorization for dextroamphetamine sulfate 1 MG/ML Oral Solution. Step therapy: 0%. Quantity limits: 68.8%.
How much does Medicare spend on dextroamphetamine sulfate 1 MG/ML Oral Solution?
In 2023, total Medicare Part D spending on dextroamphetamine sulfate 1 MG/ML Oral Solution 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.