doxycycline hyclate 100 MG Delayed Release Oral Tablet
doxycycline hyclate
RxCUI: 434018
What the CMS Formulary Data Shows for doxycycline hyclate 100 MG Delayed Release Oral Tablet
Per the CMS 2026 Part D formulary file, doxycycline hyclate 100 MG Delayed Release Oral Tablet (RxNorm concept RXCUI 434018, generic name doxycycline hyclate) appears on 15 distinct formulary files spanning 105 Medicare Part D plan offerings - 2.1% 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 2.7.
Real-world access to doxycycline hyclate 100 MG Delayed Release Oral Tablet depends on utilization management as much as tier placement: 0% 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 4,121,486 Part D beneficiaries filled doxycycline hyclate 100 MG Delayed Release Oral Tablet in 2023, with total plan-and-beneficiary spending of $117,340,524 and an average per-beneficiary annual cost of $28.47. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry doxycycline hyclate 100 MG Delayed Release Oral Tablet today.
Coverage Details
- Formularies covering
- 15
- Plans covering
- 105
- Coverage rate
- 2.1%
- 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
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 4,121,486
- Total spending
- $117,340,524
- Avg per beneficiary
- $28.47
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering doxycycline hyclate 100 MG Delayed Release Oral Tablet
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP) | HM HEALTH INSURANCE COMPANY | T2 | No | No | $164.80 | - |
| Blue Rx PDP Plus (PDP) | HM HEALTH INSURANCE COMPANY | T2 | No | No | $193.20 | - |
Medicare Advantage Plans (MA-PD) Covering doxycycline hyclate 100 MG Delayed Release Oral Tablet
98 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| CareAdvantage (HMO D-SNP) | SAN MATEO HEALTH COMMISSION | T1 | No | $0 | CA |
| 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 |
| 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 |
| Gold Heart & Diabetes (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T2 | No | $0 | FL |
| Gold Heart & Diabetes Complete (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T2 | No | $0 | FL |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T2 | No | $0 | FL |
| Gold Health (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T2 | No | $0 | FL |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T2 | No | $0 | FL |
| Gold Heart & Diabetes (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T2 | No | $0 | AZ |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T2 | No | $0 | AZ |
| Gold Heart & Diabetes (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T2 | No | $0 | AZ |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T2 | No | $0 | AZ |
| Security Blue HMO-POS Standard (HMO-POS) | HIGHMARK CHOICE COMPANY | T2 | No | $51.80 | PA |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T2 | No | $95.70 | PA |
| Security Blue HMO-POS Deluxe (HMO-POS) | HIGHMARK CHOICE COMPANY | T2 | No | $95.90 | PA |
| Freedom Blue PPO Standard (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T2 | No | $98.20 | PA |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T2 | No | $115.70 | PA |
| Freedom Blue PPO Deluxe (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T2 | No | $122.40 | PA |
| Freedom Blue PPO Classic (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T2 | No | $140.90 | PA |
| Freedom Blue PPO Classic (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T2 | No | $145.40 | PA |
| Community Blue Medicare HMO Signature (HMO) | Highmark Western and Northeastern New York Inc. | T4 | No | $0 | NY |
| Community Blue Medicare HMO Merit (HMO) | Highmark Western and Northeastern New York Inc. | T4 | No | $0 | NY |
| Community Blue Medicare PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $0 | PA |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $0 | PA |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $0 | PA |
| Complete Blue PPO Merit (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $0 | PA |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $0 | PA |
| Complete Blue PPO Distinct (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $0 | PA |
| Complete Blue Plus PPO Merit (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $0 | PA |
| Community Blue Medicare PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $0 | PA |
| Complete Blue PPO Merit (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $0 | PA |
| Community Blue Medicare HMO Signature (HMO) | HIGHMARK CHOICE COMPANY | T4 | No | $0 | PA |
| Security Blue HMO-POS ValueRx (HMO-POS) | HIGHMARK CHOICE COMPANY | T4 | No | $0 | PA |
| Community Blue Medicare HMO Signature (HMO) | HIGHMARK CHOICE COMPANY | T4 | No | $0 | PA |
| Together Blue Medicare HMO Signature (HMO) | HIGHMARK CHOICE COMPANY | T4 | No | $0 | PA |
| Community Blue Medicare HMO Distinct (HMO) | HIGHMARK CHOICE COMPANY | T4 | No | $0 | PA |
| Complete Blue HMO Distinct (HMO) | HIGHMARK CHOICE COMPANY | T4 | No | $0 | PA |
| Complete Blue PPO Distinct (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T4 | No | $0 | WV |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T4 | No | $0 | WV |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T4 | No | $0 | WV |
| Complete Blue PPO Merit (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T4 | No | $0 | WV |
| Complete Blue PPO Signature (PPO) | HIGHMARK BCBSD INC. | T4 | No | $0 | DE |
| Medicare BlueEssential (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Medicare BlueActive (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
Frequently Asked Questions
Is doxycycline hyclate 100 MG Delayed Release Oral Tablet covered by Medicare Part D?
Yes, doxycycline hyclate 100 MG Delayed Release Oral Tablet is covered by 105 Medicare Part D plans (2.1% of all Part D formularies).
What tier is doxycycline hyclate 100 MG Delayed Release Oral Tablet on Medicare Part D plans?
doxycycline hyclate 100 MG Delayed Release Oral Tablet averages Tier 2.7 across Part D plans, ranging from Tier 1 to Tier 4.
Does doxycycline hyclate 100 MG Delayed Release Oral Tablet require prior authorization?
0% of Part D formularies require prior authorization for doxycycline hyclate 100 MG Delayed Release Oral Tablet. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on doxycycline hyclate 100 MG Delayed Release Oral Tablet?
In 2023, total Medicare Part D spending on doxycycline hyclate 100 MG Delayed Release Oral Tablet was $117,340,524, covering 4,121,486 beneficiaries. The average spend per beneficiary was $28.47.
Read our methodology - how this data is sourced, computed, and verified.