dichlorphenamide 50 MG Oral Tablet [Keveyis]
dichlorphenamide
RxCUI: 1661799
What the CMS Formulary Data Shows for dichlorphenamide 50 MG Oral Tablet [Keveyis]
Per the CMS 2026 Part D formulary file, dichlorphenamide 50 MG Oral Tablet [Keveyis] (RxNorm concept RXCUI 1661799, generic name dichlorphenamide) appears on 10 distinct formulary files spanning 47 Medicare Part D plan offerings - 0.9% 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 4.2.
Real-world access to dichlorphenamide 50 MG Oral Tablet [Keveyis] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 60% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 98 Part D beneficiaries filled dichlorphenamide 50 MG Oral Tablet [Keveyis] in 2023, with total plan-and-beneficiary spending of $20,667,743 and an average per-beneficiary annual cost of $210,895.34. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry dichlorphenamide 50 MG Oral Tablet [Keveyis] today.
Coverage Details
- Formularies covering
- 10
- Plans covering
- 47
- Coverage rate
- 0.9%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 60% of formularies
2023 Medicare Spending
- Beneficiaries
- 98
- Total spending
- $20,667,743
- Avg per beneficiary
- $210,895.34
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering dichlorphenamide 50 MG Oral Tablet [Keveyis]
47 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Flex (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Active (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Select Health Medicare Wellness (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Healthy Mississippi Premier Advantage (HMO-POS) | Healthy Mississippi, Inc. | T5 | Yes | $0 | MS |
| Prominence Plus (HMO) | PROMINENCE HEALTHFIRST | T5 | Yes | $0 | NV |
| Prominence Plus (HMO) | PROMINENCE HEALTHFIRST | T5 | Yes | $0 | NV |
| Prominence Dual (HMO D-SNP) | PROMINENCE HEALTHFIRST | T5 | Yes | $0 | NV |
| Prominence Dual (HMO D-SNP) | PROMINENCE HEALTHFIRST | T5 | Yes | $0 | NV |
| Prominence Giveback (HMO) | PROMINENCE HEALTHFIRST | T5 | Yes | $0 | NV |
| Prominence Plus (HMO) | PROMINENCE HEALTHFIRST OF FLORIDA INC | T5 | Yes | $0 | FL |
| Prominence Giveback (HMO) | PROMINENCE HEALTHFIRST OF FLORIDA INC | T5 | Yes | $0 | FL |
| Prominence Plus (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Plus (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Dual (HMO D-SNP) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Extra Help (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Beyond (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Giveback (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Giveback (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Dual (HMO D-SNP) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Beyond (HMO-POS) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Dual (HMO D-SNP) | PROMINENCE HEALTHFIRST OF FLORIDA INC | T5 | Yes | $0 | FL |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | PROMINENCE HEALTHFIRST | T5 | Yes | $0 | NV |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | PROMINENCE HEALTHFIRST OF FLORIDA INC | T5 | Yes | $0 | FL |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Diabetes and Heart Care Plus (HMO C-SNP) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Mass General Brigham Advantage (PPO) | Mass General Brigham Health Plan, Inc. | T5 | Yes | $0 | MA |
| Prominence Extra Help (HMO) | PROMINENCE HEALTHFIRST | T5 | Yes | $4.20 | NV |
| Prominence Extra Help (HMO) | PROMINENCE HEALTHFIRST OF FLORIDA INC | T5 | Yes | $4.80 | FL |
| Prominence Extra Help (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $4.80 | TX |
| Prominence Extra Help (HMO) | PROMINENCE HEALTHFIRST | T5 | Yes | $9.50 | NV |
| Mass General Brigham Advantage Secure (HMO-POS) | Mass General Brigham Health Plan, Inc. | T5 | Yes | $62.00 | MA |
| Mass General Brigham Advantage Premier (PPO) | Mass General Brigham Health Plan, Inc. | T5 | Yes | $79.70 | MA |
| Mass General Brigham Advantage Signature (PPO) | Mass General Brigham Health Plan, Inc. | T5 | Yes | $147.20 | MA |
Frequently Asked Questions
Is dichlorphenamide 50 MG Oral Tablet [Keveyis] covered by Medicare Part D?
Yes, dichlorphenamide 50 MG Oral Tablet [Keveyis] is covered by 47 Medicare Part D plans (0.9% of all Part D formularies).
What tier is dichlorphenamide 50 MG Oral Tablet [Keveyis] on Medicare Part D plans?
dichlorphenamide 50 MG Oral Tablet [Keveyis] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 5.
Does dichlorphenamide 50 MG Oral Tablet [Keveyis] require prior authorization?
100% of Part D formularies require prior authorization for dichlorphenamide 50 MG Oral Tablet [Keveyis]. Step therapy: 0%. Quantity limits: 60%.
How much does Medicare spend on dichlorphenamide 50 MG Oral Tablet [Keveyis]?
In 2023, total Medicare Part D spending on dichlorphenamide 50 MG Oral Tablet [Keveyis] was $20,667,743, covering 98 beneficiaries. The average spend per beneficiary was $210,895.34.
Read our methodology - how this data is sourced, computed, and verified.