Medicare Part D coverage · estradiol · RxCUI 728122
estradiol 1.53 MG/ACTUAT Topical Spray [Evamist]
Per the CMS 2026 Part D formulary file, estradiol 1.53 MG/ACTUAT Topical Spray [Evamist] is covered by 43 Medicare Part D plans (0.9% of enrollable products), averaging Tier 4, with prior authorization required on 16.7% of covering formularies.
- 0.9%
- Plan coverage
- 43
- Plans covering
- T4
- Avg tier
- 16.7%
- Prior auth required
What the CMS Formulary Data Shows for estradiol 1.53 MG/ACTUAT Topical Spray [Evamist]
Per the CMS 2026 Part D formulary file, estradiol 1.53 MG/ACTUAT Topical Spray [Evamist] (RxNorm concept RXCUI 728122, generic name estradiol) appears on 6 distinct formulary files spanning 43 Medicare Part D plan offerings - 0.9% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 4 to Tier 4, with a cross-plan average of Tier 4.
Real-world access to estradiol 1.53 MG/ACTUAT Topical Spray [Evamist] depends on utilization management as much as tier placement: 16.7% 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 1,289,816 Part D beneficiaries filled estradiol 1.53 MG/ACTUAT Topical Spray [Evamist] in 2023, with total plan-and-beneficiary spending of $239,028,017 and an average per-beneficiary annual cost of $185.32. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry estradiol 1.53 MG/ACTUAT Topical Spray [Evamist] today.
Coverage Details
- Formularies covering
- 6
- Plans covering
- 43
- Coverage rate
- 0.9%
- Tier range
- Tier 4, Non-Preferred
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 16.7% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,289,816
- Total spending
- $239,028,017
- Avg per beneficiary
- $185.32
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering estradiol 1.53 MG/ACTUAT Topical Spray [Evamist]
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP) | HM Health Insurance Company | T4 | No | No | $164.80 | - |
| Blue Rx PDP Plus (PDP) | HM Health Insurance Company | T4 | No | No | $193.20 | - |
Medicare Advantage Plans (MA-PD) Covering estradiol 1.53 MG/ACTUAT Topical Spray [Evamist]
41 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| Network Health Select (PPO) | Network Health Insurance Corporation | T4 | No | $0 | WI |
| Network Health Go (PPO) | Network Health Insurance Corporation | T4 | No | $0 | WI |
| Network Health Anywhere (PPO) | Network Health Insurance Corporation | T4 | No | $0 | WI |
| Network Health Choice (PPO) | Network Health Insurance Corporation | T4 | No | $0 | WI |
| Network Health Zero (PPO) | Network Health Insurance Corporation | T4 | No | $0 | WI |
| Presbyterian Senior Care Plan 2 with Rx (HMO) | Presbyterian Health Plan | T4 | Yes | $0 | NM |
| Presbyterian Dual Plus (HMO D-SNP) | Presbyterian Health Plan | T4 | Yes | $0 | NM |
| Presbyterian Senior Care Extra Health Plan with Rx (HMO) | Presbyterian Health Plan | T4 | Yes | $0 | NM |
| CDPHP $0 Medicare Rx (HMO) | Capital District Physicians' Health Plan, Inc. | T4 | No | $0 | NY |
| Network Health Cares (PPO D-SNP) | Network Health Insurance Corporation | T4 | No | $21.10 | WI |
| Univera SeniorChoice Core (PPO) | Excellus Health Plan, Inc. | T4 | No | $33.00 | NY |
| Univera SeniorChoice Advanced (HMO-POS) | Excellus Health Plan, Inc. | T4 | No | $36.90 | NY |
Show the next 21 plans
| Network Health PlusRx (PPO) | Network Health Insurance Corporation | T4 | No | $38.60 | WI |
| Medicare BlueClassic (PPO) | Excellus Health Plan, Inc. | T4 | No | $51.00 | NY |
| Security Blue HMO-POS Standard (HMO-POS) | Highmark Choice Company | T4 | No | $51.80 | PA |
| 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 |
| Medicare Blue Choice Prime (HMO) | Excellus Health Plan, Inc. | T4 | No | $55.00 | NY |
| Univera SeniorChoice Value Plus (HMO-POS) | Excellus Health Plan, Inc. | T4 | No | $58.60 | NY |
| Presbyterian Senior Care Plan 3 with Rx (HMO) | Presbyterian Health Plan | T4 | Yes | $65.80 | NM |
| Medicare BlueEnhanced (PPO) | Excellus Health Plan, Inc. | T4 | No | $70.30 | NY |
| Medicare BluePlus (PPO) | Excellus Health Plan, Inc. | T4 | No | $86.40 | NY |
| Network Health PremierRx (PPO) | Network Health Insurance Corporation | T4 | No | $92.80 | WI |
| Freedom Blue PPO Select (PPO) | Highmark Senior Health Company | T4 | No | $95.70 | PA |
| Security Blue HMO-POS Deluxe (HMO-POS) | Highmark Choice Company | T4 | No | $95.90 | PA |
| Freedom Blue PPO Standard (PPO) | Highmark Senior Health Company | T4 | No | $98.20 | PA |
| CDPHP Clear Rx (HMO) | Capital District Physicians' Health Plan, Inc. | T4 | No | $100.00 | NY |
| Freedom Blue PPO Select (PPO) | Highmark Senior Health Company | T4 | No | $115.70 | PA |
| Freedom Blue PPO Deluxe (PPO) | Highmark Senior Health Company | T4 | No | $122.40 | PA |
| CDPHP Choice Rx (HMO) | Capital District Physicians' Health Plan, Inc. | T4 | No | $135.00 | NY |
| Freedom Blue PPO Classic (PPO) | Highmark Senior Health Company | T4 | No | $140.90 | PA |
| Freedom Blue PPO Classic (PPO) | Highmark Senior Health Company | T4 | No | $145.40 | PA |
| Medicare Blue Choice Optimum (HMO-POS) | Excellus Health Plan, Inc. | T4 | No | $146.00 | NY |
Frequently Asked Questions
Is estradiol 1.53 MG/ACTUAT Topical Spray [Evamist] covered by Medicare Part D?
Yes, estradiol 1.53 MG/ACTUAT Topical Spray [Evamist] is covered by 43 Medicare Part D plans (0.9% of all Part D formularies).
What tier is estradiol 1.53 MG/ACTUAT Topical Spray [Evamist] on Medicare Part D plans?
estradiol 1.53 MG/ACTUAT Topical Spray [Evamist] averages Tier 4 across Part D plans, ranging from Tier 4 to Tier 4.
Does estradiol 1.53 MG/ACTUAT Topical Spray [Evamist] require prior authorization?
16.7% of Part D formularies require prior authorization for estradiol 1.53 MG/ACTUAT Topical Spray [Evamist]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on estradiol 1.53 MG/ACTUAT Topical Spray [Evamist]?
In 2023, total Medicare Part D spending on estradiol 1.53 MG/ACTUAT Topical Spray [Evamist] was $239,028,017, covering 1,289,816 beneficiaries. The average spend per beneficiary was $185.32.
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
- dihydroergotamine mesylate 0.5 MG/ACTUAT Metered Dose Nasal Spray T4
- 0.5 ML darbepoetin alfa 0.2 MG/ML Prefilled Syringe [Aranesp] T4
- amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia] T4
- timolol hemihydrate 5 MG/ML Ophthalmic Solution [Betimol] T4
- deflazacort 18 MG Oral Tablet [Jaythari] T4
- bepotastine besilate 15 MG/ML Ophthalmic Solution [Bepreve] T4
Similar prior-authorization rate
- quetiapine 150 MG Oral Tablet 16.7% PA
- naldemedine 0.2 MG Oral Tablet [Symproic] 16.7% PA
- ziprasidone 20 MG Injection 16.8% PA
- morphine sulfate 20 MG/ML Oral Solution 16.9% PA
- 1000 ML glucose 100 MG/ML / sodium chloride 4.5 MG/ML Injection 16.5% PA
- chlorpromazine hydrochloride 50 MG Oral Tablet 16.5% PA