estradiol 1 MG / norethindrone acetate 0.5 MG / relugolix 40 MG Oral Tablet [Myfembree]
estradiol
RxCUI: 2556800
What the CMS Formulary Data Shows for estradiol 1 MG / norethindrone acetate 0.5 MG / relugolix 40 MG Oral Tablet [Myfembree]
Per the CMS 2026 Part D formulary file, estradiol 1 MG / norethindrone acetate 0.5 MG / relugolix 40 MG Oral Tablet [Myfembree] (RxNorm concept RXCUI 2556800, generic name estradiol) appears on 41 distinct formulary files spanning 140 Medicare Part D plan offerings - 2.8% 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 3.9.
Real-world access to estradiol 1 MG / norethindrone acetate 0.5 MG / relugolix 40 MG Oral Tablet [Myfembree] depends on utilization management as much as tier placement: 97.6% of covering formularies require prior authorization. 0% require step therapy. 19.5% 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 MG / norethindrone acetate 0.5 MG / relugolix 40 MG Oral Tablet [Myfembree] in 2023, with total plan-and-beneficiary spending of $239,154,624 and an average per-beneficiary annual cost of $185.42. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry estradiol 1 MG / norethindrone acetate 0.5 MG / relugolix 40 MG Oral Tablet [Myfembree] today.
Coverage Details
- Formularies covering
- 41
- Plans covering
- 140
- Coverage rate
- 2.8%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 97.6% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 19.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,289,816
- Total spending
- $239,154,624
- Avg per beneficiary
- $185.42
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering estradiol 1 MG / norethindrone acetate 0.5 MG / relugolix 40 MG Oral Tablet [Myfembree]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| ElderServe MAP (HMO D-SNP) | ELDERSERVE HEALTH, INC. | T1 | Yes | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | GROUP HEALTH COOPERATIVE OF EAU CLAIRE | T1 | Yes | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP | T1 | Yes | $0 | NJ |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | UPPER PENINSULA HEALTH PLAN, LLC | T1 | Yes | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | CARESOURCE GEORGIA CO. | T1 | Yes | $0 | GA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP CARESOURCE | T1 | Yes | $0 | MI |
| SeniorCare Complete (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | ALAMEDA ALLIANCE FOR HEALTH | T1 | Yes | $0 | CA |
| 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 |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF FLORIDA, INC. | T1 | Yes | $4.80 | FL |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF MICHIGAN, INC. | T1 | Yes | $8.80 | MI |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF ILLINOIS, INC. | T1 | Yes | $15.20 | IL |
| WellSense Added Value (HMO) | BOSTON MEDICAL CENTER HEALTH PLAN, INC. | T1 | Yes | $21.70 | NH |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF COLORADO, INC. | T1 | Yes | $35.20 | CO |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC. | T1 | Yes | $36.20 | NC |
| Longevity Health Plan (PPO I-SNP) | LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP | T1 | Yes | $40.00 | NJ |
| ElderServe Star (HMO I-SNP) | ELDERSERVE HEALTH, INC. | T1 | Yes | $58.80 | NY |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF NEW YORK, INC. | T1 | Yes | $58.80 | NY |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| 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 |
| The Health Plan SecureCare - Option II (HMO) | THE HEALTH PLAN OF WEST VIRGINIA, INC. | T5 | Yes | $0 | OH |
| The Health Plan SecureCare - Option II (HMO) | THE HEALTH PLAN OF WEST VIRGINIA, INC. | T5 | Yes | $0 | OH, WV |
| The Health Plan SecureCare Capitol Plan (HMO) | THE HEALTH PLAN OF WEST VIRGINIA, INC. | T5 | Yes | $0 | WV |
| The Health Plan SecureChoice Optimum (PPO) | THP INSURANCE COMPANY | T5 | Yes | $0 | OH, WV |
| WellSense Signature (HMO) | BOSTON MEDICAL CENTER HEALTH PLAN, INC. | T5 | Yes | $0 | NH |
| WellSense Signature Access (PPO) | BOSTON MEDICAL CENTER HEALTH PLAN, INC. | T5 | Yes | $0 | NH |
| Community Health Plan of WA Dual Complete (HMO D-SNP) | COMMUNITY HEALTH PLAN OF WASHINGTON | T5 | Yes | $0 | WA |
| Community Health Plan of WA Dual Select (HMO D-SNP) | COMMUNITY HEALTH PLAN OF WASHINGTON | T5 | Yes | $0 | WA |
| Essence Advantage (HMO) | ESSENCE HEALTHCARE, INC. | T5 | Yes | $0 | IL, MO |
| Essence Advantage (HMO) | ESSENCE HEALTHCARE, INC. | T5 | Yes | $0 | AR, MO |
| Essence Advantage Select (HMO) | ESSENCE HEALTHCARE, INC. | T5 | Yes | $0 | IL, MO |
| Essence Advantage (HMO) | ESSENCE HEALTHCARE, INC. | T5 | Yes | $0 | IN, KY |
| Essence Advantage Select (HMO) | ESSENCE HEALTHCARE, INC. | T5 | Yes | $0 | IL |
| Essence Advantage Choice (PPO) | ESSENCE HEALTHCARE PPO, INC. | T5 | Yes | $0 | IL, MO |
| Essence Advantage Choice (PPO) | ESSENCE HEALTHCARE PPO, INC. | T5 | Yes | $0 | AR, MO |
Frequently Asked Questions
Is estradiol 1 MG / norethindrone acetate 0.5 MG / relugolix 40 MG Oral Tablet [Myfembree] covered by Medicare Part D?
Yes, estradiol 1 MG / norethindrone acetate 0.5 MG / relugolix 40 MG Oral Tablet [Myfembree] is covered by 140 Medicare Part D plans (2.8% of all Part D formularies).
What tier is estradiol 1 MG / norethindrone acetate 0.5 MG / relugolix 40 MG Oral Tablet [Myfembree] on Medicare Part D plans?
estradiol 1 MG / norethindrone acetate 0.5 MG / relugolix 40 MG Oral Tablet [Myfembree] averages Tier 3.9 across Part D plans, ranging from Tier 1 to Tier 5.
Does estradiol 1 MG / norethindrone acetate 0.5 MG / relugolix 40 MG Oral Tablet [Myfembree] require prior authorization?
97.6% of Part D formularies require prior authorization for estradiol 1 MG / norethindrone acetate 0.5 MG / relugolix 40 MG Oral Tablet [Myfembree]. Step therapy: 0%. Quantity limits: 19.5%.
How much does Medicare spend on estradiol 1 MG / norethindrone acetate 0.5 MG / relugolix 40 MG Oral Tablet [Myfembree]?
In 2023, total Medicare Part D spending on estradiol 1 MG / norethindrone acetate 0.5 MG / relugolix 40 MG Oral Tablet [Myfembree] was $239,154,624, covering 1,289,816 beneficiaries. The average spend per beneficiary was $185.42.
Read our methodology - how this data is sourced, computed, and verified.