Medicare Part D coverage · leuprolide acetate · RxCUI 2606516
leuprolide acetate 22.5 MG Injection
Per the CMS 2026 Part D formulary file, leuprolide acetate 22.5 MG Injection is covered by 2,053 Medicare Part D plans (40.6% of enrollable products), averaging Tier 3.4, with prior authorization required on 91.2% of covering formularies.
- 40.6%
- Plan coverage
- 2,053
- Plans covering
- T3.4
- Avg tier
- 91.2%
- Prior auth required
What the CMS Formulary Data Shows for leuprolide acetate 22.5 MG Injection
Per the CMS 2026 Part D formulary file, leuprolide acetate 22.5 MG Injection (RxNorm concept RXCUI 2606516, generic name leuprolide acetate) appears on 159 distinct formulary files spanning 2,053 Medicare Part D plan offerings - 40.6% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 3.4.
Real-world access to leuprolide acetate 22.5 MG Injection depends on utilization management as much as tier placement: 91.2% of covering formularies require prior authorization. 0% require step therapy. 39.6% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 8,570 Part D beneficiaries filled leuprolide acetate 22.5 MG Injection in 2023, with total plan-and-beneficiary spending of $128,884,249 and an average per-beneficiary annual cost of $15,039.00. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry leuprolide acetate 22.5 MG Injection today.
Coverage Details
- Formularies covering
- 159
- Plans covering
- 2,053
- Coverage rate
- 40.6%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 91.2% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 39.6% of formularies
2023 Medicare Spending
- Beneficiaries
- 8,570
- Total spending
- $128,884,249
- Avg per beneficiary
- $15,039.00
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering leuprolide acetate 22.5 MG Injection
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| 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 |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | Yes | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | Yes | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $0 | NY |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $0 | AR |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | Yes | $0 | CA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
Show the next 30 plans
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | Yes | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $0 | DE |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Hcsc Insurance Services Company | T1 | Yes | $4.80 | TX |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS Insurance Company | T1 | Yes | $5.00 | OK |
| Tribute Select (HMO-POS I-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $8.90 | AR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $13.10 | PA |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | Yes | $17.00 | AZ |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $17.60 | PA |
| Alterwood Advantage Dual Value (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $31.20 | MD |
| Highmark Health Options Duals Select (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $31.20 | DE |
| Valor Health Plan (HMO I-SNP) | TSG Guard, Inc. | T1 | Yes | $31.40 | OH |
| WV Senior Advantage (HMO I-SNP) | West Virginia Senior Advantage, Inc. | T1 | Yes | $32.70 | WV |
| Hamaspik Medicare Select (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $34.50 | NY |
| Abilis Health (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $35.90 | KY, TN |
| CommuniCare Advantage ISNP (HMO I-SNP) | OH CHS SNP Inc. | T1 | Yes | $38.40 | IN, MD, OH |
| Nascentia Skilled Nursing Facility (HMO I-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $58.80 | NY |
| MCS Classicare RxMax (HMO) | MCS Advantage, Inc. | T2 | Yes | $0 | PR |
| MCS Classicare Platino Ideal (HMO D-SNP) | MCS Advantage, Inc. | T2 | Yes | $0 | PR |
| MCS Classicare Efectivo (HMO) | MCS Advantage, Inc. | T2 | Yes | $0 | PR |
| MCS Classicare Essential (HMO-POS) | MCS Advantage, Inc. | T2 | Yes | $0 | PR |
| MCS Classicare Platino Progreso (HMO D-SNP) | MCS Advantage, Inc. | T2 | Yes | $0 | PR |
| MCS Classicare Primero (HMO C-SNP) | MCS Advantage, Inc. | T2 | Yes | $0 | PR |
| MCS Classicare Firme (HMO) | MCS Advantage, Inc. | T2 | Yes | $0 | PR |
| MCS Classicare En Tu Hogar (HMO) | MCS Advantage, Inc. | T2 | Yes | $0 | PR |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is leuprolide acetate 22.5 MG Injection covered by Medicare Part D?
Yes, leuprolide acetate 22.5 MG Injection is covered by 2,053 Medicare Part D plans (40.6% of all Part D formularies).
What tier is leuprolide acetate 22.5 MG Injection on Medicare Part D plans?
leuprolide acetate 22.5 MG Injection averages Tier 3.4 across Part D plans, ranging from Tier 1 to Tier 4.
Does leuprolide acetate 22.5 MG Injection require prior authorization?
91.2% of Part D formularies require prior authorization for leuprolide acetate 22.5 MG Injection. Step therapy: 0%. Quantity limits: 39.6%.
How much does Medicare spend on leuprolide acetate 22.5 MG Injection?
In 2023, total Medicare Part D spending on leuprolide acetate 22.5 MG Injection was $128,884,249, covering 8,570 beneficiaries. The average spend per beneficiary was $15,039.00.
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
- midazolam 50 MG/ML Nasal Spray [Nayzilam] T3.4
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Similar prior-authorization rate
- 0.25 ML ixekizumab 80 MG/ML Prefilled Syringe [Taltz] 91.3% PA
- 0.5 ML ixekizumab 80 MG/ML Prefilled Syringe [Taltz] 91.3% PA
- tretinoin 0.0001 MG/MG Topical Gel 91% PA
- tretinoin 0.00025 MG/MG Topical Gel 91% PA
- deferasirox 125 MG Tablet for Oral Suspension 91% PA
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