Medicare Part D coverage · isotretinoin · RxCUI 1547565
isotretinoin 35 MG Oral Capsule
Per the CMS 2026 Part D formulary file, isotretinoin 35 MG Oral Capsule is covered by 2,081 Medicare Part D plans (41.2% of enrollable products), averaging Tier 3.6, with prior authorization required on 64.8% of covering formularies.
- 41.2%
- Plan coverage
- 2,081
- Plans covering
- T3.6
- Avg tier
- 64.8%
- Prior auth required
What the CMS Formulary Data Shows for isotretinoin 35 MG Oral Capsule
Per the CMS 2026 Part D formulary file, isotretinoin 35 MG Oral Capsule (RxNorm concept RXCUI 1547565, generic name isotretinoin) appears on 71 distinct formulary files spanning 2,081 Medicare Part D plan offerings - 41.2% 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 3.6.
Real-world access to isotretinoin 35 MG Oral Capsule depends on utilization management as much as tier placement: 64.8% 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 2,097 Part D beneficiaries filled isotretinoin 35 MG Oral Capsule in 2023, with total plan-and-beneficiary spending of $1,429,494 and an average per-beneficiary annual cost of $681.69. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry isotretinoin 35 MG Oral Capsule today.
Coverage Details
- Formularies covering
- 71
- Plans covering
- 2,081
- Coverage rate
- 41.2%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 64.8% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 2,097
- Total spending
- $1,429,494
- Avg per beneficiary
- $681.69
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering isotretinoin 35 MG Oral Capsule
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 isotretinoin 35 MG Oral Capsule
98 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 |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | Yes | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | Yes | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| 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 |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Hcsc Insurance Services Company | T1 | Yes | $4.80 | TX |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS Insurance Company | T1 | Yes | $5.00 | OK |
| Hamaspik Medicare Select (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $34.50 | NY |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun MediMax (HMO) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
Show the next 30 plans
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun MediSun Plus (HMO D-SNP) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun MediSun Extra (HMO D-SNP) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun MediSun Full Dual Plus (HMO D-SNP) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun MediSun Full Dual Extra (HMO D-SNP) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply Extra (HMO) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply Extra Platinum (HMO) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply More Platinum (HMO) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply Complete Platinum (HMO D-SNP) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
Showing top 50 of 98 plans.
Frequently Asked Questions
Is isotretinoin 35 MG Oral Capsule covered by Medicare Part D?
Yes, isotretinoin 35 MG Oral Capsule is covered by 2,081 Medicare Part D plans (41.2% of all Part D formularies).
What tier is isotretinoin 35 MG Oral Capsule on Medicare Part D plans?
isotretinoin 35 MG Oral Capsule averages Tier 3.6 across Part D plans, ranging from Tier 1 to Tier 5.
Does isotretinoin 35 MG Oral Capsule require prior authorization?
64.8% of Part D formularies require prior authorization for isotretinoin 35 MG Oral Capsule. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on isotretinoin 35 MG Oral Capsule?
In 2023, total Medicare Part D spending on isotretinoin 35 MG Oral Capsule was $1,429,494, covering 2,097 beneficiaries. The average spend per beneficiary was $681.69.
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
- lomustine 40 MG Oral Capsule [Gleostine] T3.6
- escitalopram 15 MG Oral Capsule T3.6
- clindamycin 10 MG/ML Topical Foam [Clindacin] T3.6
- 90 DAY estradiol 0.000313 MG/HR Vaginal System [Estring] T3.5
- estradiol cypionate 5 MG/ML Injectable Solution [Depo-estradiol] T3.5
- bromocriptine 0.8 MG Oral Tablet [Cycloset] T3.5
Similar prior-authorization rate
- carisoprodol 250 MG Oral Tablet 65% PA
- acetaminophen 325 MG / butalbital 50 MG Oral Tablet 64.5% PA
- ivermectin 3 MG Oral Tablet 63.7% PA
- miltefosine 50 MG Oral Capsule [Impavido] 65.9% PA
- lactulose 20000 MG Powder for Oral Solution [Kristalose] 63.6% PA
- tiopronin 100 MG Delayed Release Oral Tablet 63.3% PA