leuprolide acetate 22.5 MG Injection [Lutrate]
leuprolide acetate
RxCUI: 2709448
What the CMS Formulary Data Shows for leuprolide acetate 22.5 MG Injection [Lutrate]
Per the CMS 2026 Part D formulary file, leuprolide acetate 22.5 MG Injection [Lutrate] (RxNorm concept RXCUI 2709448, generic name leuprolide acetate) appears on 80 distinct formulary files spanning 1,273 Medicare Part D plan offerings - 25.1% 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 [Lutrate] depends on utilization management as much as tier placement: 97.5% of covering formularies require prior authorization. 0% require step therapy. 15% 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 [Lutrate] 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 [Lutrate] today.
Coverage Details
- Formularies covering
- 80
- Plans covering
- 1,273
- Coverage rate
- 25.1%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 97.5% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 15% of formularies
2023 Medicare Spending
- Beneficiaries
- 8,570
- Total spending
- $128,884,249
- Avg per beneficiary
- $15,039.00
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering leuprolide acetate 22.5 MG Injection [Lutrate]
9 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | Yes | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering leuprolide acetate 22.5 MG Injection [Lutrate]
91 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| 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 |
| 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 |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T1 | Yes | $17.00 | AZ |
| Alterwood Advantage Dual Value (HMO D-SNP) | ALTERWOOD ADVANTAGE, INC. | T1 | Yes | $31.20 | MD |
| 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 |
| 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 |
| PHP (HMO C-SNP) | AIDS HEALTHCARE FOUNDATION | T3 | Yes | $0 | CA |
| DualConnect (HMO D-SNP) | SANTA CLARA COUNTY HEALTH AUTHORITY | T3 | Yes | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS CHOICE | T3 | Yes | $0 | NY |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS CHOICE | T3 | Yes | $51.60 | NY |
| HAP Medicare Explore (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T4 | No | $0 | MI |
| HAP Medicare Prime (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T4 | No | $0 | MI |
| HAP Medicare Connect (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T4 | No | $0 | MI |
| HAP Medicare Complete Duals (HMO D-SNP) | HEALTH ALLIANCE PLAN OF MICHIGAN | T4 | No | $0 | MI |
| HAP Medicare Superior (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T4 | No | $0 | MI |
| Henry Ford Select (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T4 | No | $0 | MI |
| HealthSpring Preferred (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T4 | Yes | $0 | AZ |
| HealthSpring Alliance (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T4 | Yes | $0 | AZ |
| HealthSpring Preferred Savings (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T4 | Yes | $0 | AZ |
| HealthSpring Preferred Full Savings (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T4 | Yes | $0 | AZ |
| HealthSpring Preferred GA (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | Yes | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | Yes | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | Yes | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | Yes | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | Yes | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | Yes | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | Yes | $0 | GA |
| HealthSpring Preferred Savings (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | Yes | $0 | GA |
| HealthSpring Preferred Savings (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | Yes | $0 | GA |
| HealthSpring Preferred Savings (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | Yes | $0 | GA |
| HealthSpring Preferred Savings (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | Yes | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | Yes | $0 | MO |
Frequently Asked Questions
Is leuprolide acetate 22.5 MG Injection [Lutrate] covered by Medicare Part D?
Yes, leuprolide acetate 22.5 MG Injection [Lutrate] is covered by 1,273 Medicare Part D plans (25.1% of all Part D formularies).
What tier is leuprolide acetate 22.5 MG Injection [Lutrate] on Medicare Part D plans?
leuprolide acetate 22.5 MG Injection [Lutrate] averages Tier 3.4 across Part D plans, ranging from Tier 1 to Tier 4.
Does leuprolide acetate 22.5 MG Injection [Lutrate] require prior authorization?
97.5% of Part D formularies require prior authorization for leuprolide acetate 22.5 MG Injection [Lutrate]. Step therapy: 0%. Quantity limits: 15%.
How much does Medicare spend on leuprolide acetate 22.5 MG Injection [Lutrate]?
In 2023, total Medicare Part D spending on leuprolide acetate 22.5 MG Injection [Lutrate] 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.