Medicare Part D coverage · insulin lispro · RxCUI 242120
insulin lispro 100 UNT/ML Injectable Solution
Per the CMS 2026 Part D formulary file, insulin lispro 100 UNT/ML Injectable Solution is covered by 2,635 Medicare Part D plans (52.2% of enrollable products), averaging Tier 2.6, with prior authorization required on 18.4% of covering formularies.
- 52.2%
- Plan coverage
- 2,635
- Plans covering
- T2.6
- Avg tier
- 18.4%
- Prior auth required
What the CMS Formulary Data Shows for insulin lispro 100 UNT/ML Injectable Solution
Per the CMS 2026 Part D formulary file, insulin lispro 100 UNT/ML Injectable Solution (RxNorm concept RXCUI 242120, generic name insulin lispro) appears on 179 distinct formulary files spanning 2,635 Medicare Part D plan offerings - 52.2% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 7, with a cross-plan average of Tier 2.6.
Real-world access to insulin lispro 100 UNT/ML Injectable Solution depends on utilization management as much as tier placement: 18.4% of covering formularies require prior authorization. 0.6% require step therapy. 28.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 418,431 Part D beneficiaries filled insulin lispro 100 UNT/ML Injectable Solution in 2023, with total plan-and-beneficiary spending of $1,208,385,334 and an average per-beneficiary annual cost of $2,887.90. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry insulin lispro 100 UNT/ML Injectable Solution today.
Coverage Details
- Formularies covering
- 179
- Plans covering
- 2,635
- Coverage rate
- 52.2%
- Tier range
- Tier 1 – Tier 7
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 18.4% of formularies
- Step therapy required
- 0.6% of formularies
- Quantity limits
- 28.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 418,431
- Total spending
- $1,208,385,334
- Avg per beneficiary
- $2,887.90
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering insulin lispro 100 UNT/ML Injectable Solution
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $0 | NJ |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | No | $0 | GA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | No | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | Yes | $0 | AL |
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T1 | No | $0 | CA |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | No | $0 | CA |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | No | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | No | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
Show the next 30 plans
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $0 | MO |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | No | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | No | $0 | AR |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Advance (HMO D-snp) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Plus (HMO D-snp) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| FHCP Medicare Classic (HMO) | Florida Blue Medicare, Inc. | T1 | No | $0 | FL |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | No | $0 | CA |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | No | $4.80 | FL |
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | Yes | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | American Health Plan OF FL, Inc. | T1 | Yes | $4.80 | FL |
| SECUR Advantage (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| SECUR Enhanced (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | No | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | No | $4.80 | TX |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | No | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | No | $4.80 | TX |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | No | $8.80 | MI |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is insulin lispro 100 UNT/ML Injectable Solution covered by Medicare Part D?
Yes, insulin lispro 100 UNT/ML Injectable Solution is covered by 2,635 Medicare Part D plans (52.2% of all Part D formularies).
What tier is insulin lispro 100 UNT/ML Injectable Solution on Medicare Part D plans?
insulin lispro 100 UNT/ML Injectable Solution averages Tier 2.6 across Part D plans, ranging from Tier 1 to Tier 7.
Does insulin lispro 100 UNT/ML Injectable Solution require prior authorization?
18.4% of Part D formularies require prior authorization for insulin lispro 100 UNT/ML Injectable Solution. Step therapy: 0.6%. Quantity limits: 28.5%.
How much does Medicare spend on insulin lispro 100 UNT/ML Injectable Solution?
In 2023, total Medicare Part D spending on insulin lispro 100 UNT/ML Injectable Solution was $1,208,385,334, covering 418,431 beneficiaries. The average spend per beneficiary was $2,887.90.
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
- 1 ML haloperidol decanoate 50 MG/ML Injection T2.6
- 12 HR carbamazepine 100 MG Extended Release Oral Tablet T2.6
- {74 (apixaban 5 MG Oral Tablet [Eliquis]) } Pack [Eliquis 30-Day Starter Pack] T2.6
- apixaban 2.5 MG Oral Tablet [Eliquis] T2.6
- bacitracin 0.5 UNT/MG Ophthalmic Ointment T2.6
- chloroquine phosphate 250 MG Oral Tablet T2.6
Similar prior-authorization rate
- zaleplon 10 MG Oral Capsule 18.4% PA
- tretinoin 10 MG Oral Capsule 18.3% PA
- promethazine hydrochloride 12.5 MG Rectal Suppository 18.3% PA
- betaine 1000 MG Powder for Oral Solution 18.2% PA
- eszopiclone 3 MG Oral Tablet 18.2% PA
- chlorpromazine hydrochloride 10 MG Oral Tablet 18.6% PA