doxycycline hyclate 150 MG Delayed Release Oral Tablet
doxycycline hyclate
RxCUI: 799048
What the CMS Formulary Data Shows for doxycycline hyclate 150 MG Delayed Release Oral Tablet
Per the CMS 2026 Part D formulary file, doxycycline hyclate 150 MG Delayed Release Oral Tablet (RxNorm concept RXCUI 799048, generic name doxycycline hyclate) appears on 13 distinct formulary files spanning 63 Medicare Part D plan offerings - 1.2% 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 2.6.
Real-world access to doxycycline hyclate 150 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 150 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 150 MG Delayed Release Oral Tablet today.
Coverage Details
- Formularies covering
- 13
- Plans covering
- 63
- Coverage rate
- 1.2%
- 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 150 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 | T3 | No | No | $164.80 | - |
| Blue Rx PDP Plus (PDP) | HM HEALTH INSURANCE COMPANY | T3 | No | No | $193.20 | - |
Medicare Advantage Plans (MA-PD) Covering doxycycline hyclate 150 MG Delayed Release Oral Tablet
61 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 | T3 | No | $51.80 | PA |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T3 | No | $95.70 | PA |
| Security Blue HMO-POS Deluxe (HMO-POS) | HIGHMARK CHOICE COMPANY | T3 | No | $95.90 | PA |
| Freedom Blue PPO Standard (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T3 | No | $98.20 | PA |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T3 | No | $115.70 | PA |
| Freedom Blue PPO Deluxe (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T3 | No | $122.40 | PA |
| Freedom Blue PPO Classic (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T3 | No | $140.90 | PA |
| Freedom Blue PPO Classic (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T3 | No | $145.40 | PA |
| Medicare BlueEssential (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Medicare BlueActive (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Medicare BlueVital (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Univera SeniorChoice Basic (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Univera SeniorChoice Extra (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Medicare Blue Choice Core (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Univera Medicare Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T4 | No | $0 | NY |
| Medicare Blue Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T4 | No | $0 | NY |
| Geisinger Gold Preferred Complete Rx (PPO) | GEISINGER INDEMNITY INSURANCE COMPANY | T4 | No | $0 | PA |
| Geisinger Gold Secure Rx (HMO D-SNP) | GEISINGER HEALTH PLAN | T4 | No | $0 | PA |
| Geisinger Gold Classic 360 Rx (HMO) | GEISINGER HEALTH PLAN | T4 | No | $0 | PA |
| Geisinger Gold Classic Essential Rx (HMO) | GEISINGER HEALTH PLAN | T4 | No | $0 | PA |
| SummaCare Medicare Topaz (HMO) | SUMMACARE INC. | T4 | No | $0 | OH |
| SummaCare Medicare Quartz (HMO) | SUMMACARE INC. | T4 | No | $0 | OH |
| VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) | VILLAGE SENIOR SERVICES CORPORATION | T4 | No | $0 | NY |
| VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) | VILLAGE SENIOR SERVICES CORPORATION | T4 | No | $0 | NY |
| CDPHP $0 Medicare Rx (HMO) | CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Geisinger Gold Value Rx (HMO) | GEISINGER HEALTH PLAN | T4 | No | $23.00 | PA |
| Univera SeniorChoice Core (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $33.00 | NY |
| SummaCare Medicare Garnet (HMO) | SUMMACARE INC. | T4 | No | $35.00 | OH |
| Univera SeniorChoice Advanced (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $36.90 | NY |
| Geisinger Gold Classic Complete Rx (HMO) | GEISINGER HEALTH PLAN | T4 | No | $48.00 | PA |
| SummaCare Medicare Ruby (HMO) | SUMMACARE INC. | T4 | No | $50.00 | OH |
| Medicare BlueClassic (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $51.00 | NY |
| Univera SeniorChoice Secure (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $54.90 | NY |
| Medicare BlueBalanced (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $55.00 | NY |
Frequently Asked Questions
Is doxycycline hyclate 150 MG Delayed Release Oral Tablet covered by Medicare Part D?
Yes, doxycycline hyclate 150 MG Delayed Release Oral Tablet is covered by 63 Medicare Part D plans (1.2% of all Part D formularies).
What tier is doxycycline hyclate 150 MG Delayed Release Oral Tablet on Medicare Part D plans?
doxycycline hyclate 150 MG Delayed Release Oral Tablet averages Tier 2.6 across Part D plans, ranging from Tier 1 to Tier 4.
Does doxycycline hyclate 150 MG Delayed Release Oral Tablet require prior authorization?
0% of Part D formularies require prior authorization for doxycycline hyclate 150 MG Delayed Release Oral Tablet. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on doxycycline hyclate 150 MG Delayed Release Oral Tablet?
In 2023, total Medicare Part D spending on doxycycline hyclate 150 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.