ketoprofen 25 MG Oral Capsule
ketoprofen
RxCUI: 197854
What the CMS Formulary Data Shows for ketoprofen 25 MG Oral Capsule
Per the CMS 2026 Part D formulary file, ketoprofen 25 MG Oral Capsule (RxNorm concept RXCUI 197854, generic name ketoprofen) appears on 2 distinct formulary files spanning 26 Medicare Part D plan offerings - 0.5% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 2 to Tier 2, with a cross-plan average of Tier 2.
Real-world access to ketoprofen 25 MG Oral Capsule depends on utilization management as much as tier placement: 0% 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 1,019 Part D beneficiaries filled ketoprofen 25 MG Oral Capsule in 2023, with total plan-and-beneficiary spending of $3,673,280 and an average per-beneficiary annual cost of $3,604.79. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry ketoprofen 25 MG Oral Capsule today.
Coverage Details
- Formularies covering
- 2
- Plans covering
- 26
- Coverage rate
- 0.5%
- Tier range
- Tier 2, Generic
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,019
- Total spending
- $3,673,280
- Avg per beneficiary
- $3,604.79
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering ketoprofen 25 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 ketoprofen 25 MG Oral Capsule
24 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| MMM Supremo (HMO C-SNP) | MMM HEALTHCARE, LLC | T2 | No | $0 | PR |
| MMM Diamante Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T2 | No | $0 | PR |
| MMM Unico (HMO-POS) | MMM HEALTHCARE, LLC | T2 | No | $0 | PR |
| MMM Elite (HMO-POS) | MMM HEALTHCARE, LLC | T2 | No | $0 | PR |
| MMM Deluxe (HMO-POS) | MMM HEALTHCARE, LLC | T2 | No | $0 | PR |
| MMM Dorado Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T2 | No | $0 | PR |
| PMC Premier Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T2 | No | $0 | PR |
| PMC Max (HMO-POS) | MMM HEALTHCARE, LLC | T2 | No | $0 | PR |
| MMM Plenitud (HMO-POS) | MMM HEALTHCARE, LLC | T2 | No | $0 | PR |
| MMM Valioso (HMO-POS) | MMM HEALTHCARE, LLC | T2 | No | $0 | PR |
| MMM Combo Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T2 | No | $0 | PR |
| MMM Flexi Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T2 | No | $0 | PR |
| MMM Grandioso (HMO-POS) | MMM HEALTHCARE, LLC | T2 | No | $0 | PR |
| MMM Mega Flex (HMO-POS) | MMM HEALTHCARE, LLC | T2 | No | $0 | PR |
| MMM Relax Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T2 | No | $0 | PR |
| MMM Balance (HMO-POS) | MMM HEALTHCARE, LLC | T2 | No | $0 | PR |
| 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 |
| 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 |
Frequently Asked Questions
Is ketoprofen 25 MG Oral Capsule covered by Medicare Part D?
Yes, ketoprofen 25 MG Oral Capsule is covered by 26 Medicare Part D plans (0.5% of all Part D formularies).
What tier is ketoprofen 25 MG Oral Capsule on Medicare Part D plans?
ketoprofen 25 MG Oral Capsule averages Tier 2 across Part D plans, ranging from Tier 2 to Tier 2.
Does ketoprofen 25 MG Oral Capsule require prior authorization?
0% of Part D formularies require prior authorization for ketoprofen 25 MG Oral Capsule. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on ketoprofen 25 MG Oral Capsule?
In 2023, total Medicare Part D spending on ketoprofen 25 MG Oral Capsule was $3,673,280, covering 1,019 beneficiaries. The average spend per beneficiary was $3,604.79.
Read our methodology - how this data is sourced, computed, and verified.