Medicare Part D coverage · isotretinoin · RxCUI 1547561
isotretinoin 25 MG Oral Capsule
Per the CMS 2026 Part D formulary file, isotretinoin 25 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 25 MG Oral Capsule
Per the CMS 2026 Part D formulary file, isotretinoin 25 MG Oral Capsule (RxNorm concept RXCUI 1547561, 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 25 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 25 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 25 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 25 MG Oral Capsule
7 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 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T4 | Yes | No | $0 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T4 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T4 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T4 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T4 | Yes | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering isotretinoin 25 MG Oral Capsule
93 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 |
| Security Blue HMO-POS Standard (HMO-POS) | Highmark Choice Company | T2 | No | $51.80 | PA |
| Freedom Blue PPO Select (PPO) | Highmark Senior Health Company | T2 | No | $95.70 | PA |
Show the next 30 plans
| Security Blue HMO-POS Deluxe (HMO-POS) | Highmark Choice Company | T2 | No | $95.90 | PA |
| Freedom Blue PPO Standard (PPO) | Highmark Senior Health Company | T2 | No | $98.20 | PA |
| Freedom Blue PPO Select (PPO) | Highmark Senior Health Company | T2 | No | $115.70 | PA |
| Freedom Blue PPO Deluxe (PPO) | Highmark Senior Health Company | T2 | No | $122.40 | PA |
| Freedom Blue PPO Classic (PPO) | Highmark Senior Health Company | T2 | No | $140.90 | PA |
| Freedom Blue PPO Classic (PPO) | Highmark Senior Health Company | T2 | No | $145.40 | PA |
| Freedom VIP Care (HMO C-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Optimum Diamond Savings (HMO C-SNP) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Optimum Diamond (HMO C-SNP) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Freedom Medi-Medi Partial (HMO D-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Medi-Medi Full (HMO D-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Optimum Emerald Partial (HMO D-SNP) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Optimum Emerald Full (HMO D-SNP) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
Showing top 50 of 93 plans.
Frequently Asked Questions
Is isotretinoin 25 MG Oral Capsule covered by Medicare Part D?
Yes, isotretinoin 25 MG Oral Capsule is covered by 2,081 Medicare Part D plans (41.2% of all Part D formularies).
What tier is isotretinoin 25 MG Oral Capsule on Medicare Part D plans?
isotretinoin 25 MG Oral Capsule averages Tier 3.6 across Part D plans, ranging from Tier 1 to Tier 5.
Does isotretinoin 25 MG Oral Capsule require prior authorization?
64.8% of Part D formularies require prior authorization for isotretinoin 25 MG Oral Capsule. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on isotretinoin 25 MG Oral Capsule?
In 2023, total Medicare Part D spending on isotretinoin 25 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
- eslicarbazepine acetate 400 MG Oral Tablet T3.6
- abiraterone acetate 250 MG Oral Tablet T3.6
- 1 ML octreotide 0.5 MG/ML Injection T3.6
- phenytoin 25 MG/ML Oral Suspension [Dilantin] T3.6
- varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya] T3.6
- theophylline 100 MG Extended Release Oral Capsule [Theo-24] T3.6
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