Medicare Part D coverage · levonorgestrel · RxCUI 1605257
levonorgestrel 0.000813 MG/HR Intrauterine System [Liletta]
Per the CMS 2026 Part D formulary file, levonorgestrel 0.000813 MG/HR Intrauterine System [Liletta] is covered by 3,717 Medicare Part D plans (73.6% of enrollable products), averaging Tier 2.6, with prior authorization required on 0.7% of covering formularies.
- 73.6%
- Plan coverage
- 3,717
- Plans covering
- T2.6
- Avg tier
- 0.7%
- Prior auth required
What the CMS Formulary Data Shows for levonorgestrel 0.000813 MG/HR Intrauterine System [Liletta]
Per the CMS 2026 Part D formulary file, levonorgestrel 0.000813 MG/HR Intrauterine System [Liletta] (RxNorm concept RXCUI 1605257, generic name levonorgestrel) appears on 297 distinct formulary files spanning 3,717 Medicare Part D plan offerings - 73.6% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.6.
Real-world access to levonorgestrel 0.000813 MG/HR Intrauterine System [Liletta] depends on utilization management as much as tier placement: 0.7% of covering formularies require prior authorization. 0% require step therapy. 2.4% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 650 Part D beneficiaries filled levonorgestrel 0.000813 MG/HR Intrauterine System [Liletta] in 2023, with total plan-and-beneficiary spending of $777,252 and an average per-beneficiary annual cost of $1,195.77. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry levonorgestrel 0.000813 MG/HR Intrauterine System [Liletta] today.
Coverage Details
- Formularies covering
- 297
- Plans covering
- 3,717
- Coverage rate
- 73.6%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0.7% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 2.4% of formularies
2023 Medicare Spending
- Beneficiaries
- 650
- Total spending
- $777,252
- Avg per beneficiary
- $1,195.77
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering levonorgestrel 0.000813 MG/HR Intrauterine System [Liletta]
100 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 |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | No | $0 | FL |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $0 | NJ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | No | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | No | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | No | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | No | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | No | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | No | $0 | NY |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | No | $0 | GA |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
Show the next 30 plans
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | No | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | No | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | No | $0 | AL |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | No | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | No | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | No | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | No | $0 | CA |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | No | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | No | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | No | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | No | $0 | NY |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $0 | MO |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | No | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | No | $0 | AR |
| 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 |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is levonorgestrel 0.000813 MG/HR Intrauterine System [Liletta] covered by Medicare Part D?
Yes, levonorgestrel 0.000813 MG/HR Intrauterine System [Liletta] is covered by 3,717 Medicare Part D plans (73.6% of all Part D formularies).
What tier is levonorgestrel 0.000813 MG/HR Intrauterine System [Liletta] on Medicare Part D plans?
levonorgestrel 0.000813 MG/HR Intrauterine System [Liletta] averages Tier 2.6 across Part D plans, ranging from Tier 1 to Tier 4.
Does levonorgestrel 0.000813 MG/HR Intrauterine System [Liletta] require prior authorization?
0.7% of Part D formularies require prior authorization for levonorgestrel 0.000813 MG/HR Intrauterine System [Liletta]. Step therapy: 0%. Quantity limits: 2.4%.
How much does Medicare spend on levonorgestrel 0.000813 MG/HR Intrauterine System [Liletta]?
In 2023, total Medicare Part D spending on levonorgestrel 0.000813 MG/HR Intrauterine System [Liletta] was $777,252, covering 650 beneficiaries. The average spend per beneficiary was $1,195.77.
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
- carbamazepine 20 MG/ML Oral Suspension T2.6
- morphine sulfate 15 MG Oral Tablet T2.6
- {2 (480 ML) (magnesium sulfate 0.0277 MEQ/ML / potassium sulfate 0.0374 MEQ/ML / sodium sulfate 0.257 MEQ/ML Oral Solution) } Pack T2.6
- 6 ML clindamycin 150 MG/ML Injection T2.6
- travoprost 0.04 MG/ML Ophthalmic Solution T2.6
- 24 HR linagliptin 2.5 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Jentadueto] T2.6
Similar prior-authorization rate
- trospium chloride 20 MG Oral Tablet 0.7% PA
- mesalamine 500 MG Extended Release Oral Capsule 0.7% PA
- brimonidine tartrate 2 MG/ML / brinzolamide 10 MG/ML Ophthalmic Suspension [Simbrinza] 0.7% PA
- latanoprost 0.05 MG/ML / netarsudil 0.2 MG/ML Ophthalmic Solution [Rocklatan] 0.7% PA
- netarsudil 0.2 MG/ML Ophthalmic Solution [Rhopressa] 0.7% PA
- calcium chloride 0.2 MG/ML / glucose 50 MG/ML / potassium chloride 1.79 MG/ML / sodium chloride 6 MG/ML / sodium lactate 3.1 MG/ML Injectable Solution 0.7% PA