levonorgestrel 0.000833 MG/HR Intrauterine System [Mirena]
levonorgestrel
RxCUI: 807283
Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.
24%
Plan Coverage
1,214
Plans Covering
T3.1
Avg Tier
3.3%
Prior Auth Required
What the CMS Formulary Data Shows for levonorgestrel 0.000833 MG/HR Intrauterine System [Mirena]
Per the CMS 2026 Part D formulary file, levonorgestrel 0.000833 MG/HR Intrauterine System [Mirena] (RxNorm concept RXCUI 807283, generic name levonorgestrel) appears on 90 distinct formulary files spanning 1,214 Medicare Part D plan offerings - 24% 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 3.1.
Real-world access to levonorgestrel 0.000833 MG/HR Intrauterine System [Mirena] depends on utilization management as much as tier placement: 3.3% of covering formularies require prior authorization. 0% require step therapy. 3.3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 650 Part D beneficiaries filled levonorgestrel 0.000833 MG/HR Intrauterine System [Mirena] 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 0.000833 MG/HR Intrauterine System [Mirena] today.
Coverage Details
- Formularies covering
- 90
- Plans covering
- 1,214
- Coverage rate
- 24%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 3.3% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 3.3% of formularies
2023 Medicare Spending
- Beneficiaries
- 650
- Total spending
- $777,252
- Avg per beneficiary
- $1,195.77
Tier Distribution Across Plans
38 plans
Tier 1, Preferred Generic
2 plans
Tier 2, Generic
60 plans
Tier 3, Preferred Brand
Standalone Drug Plans (PDP) Covering levonorgestrel 0.000833 MG/HR Intrauterine System [Mirena]
26 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Value Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Value Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Value Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Value Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
| Humana Value Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T3 | No | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering levonorgestrel 0.000833 MG/HR Intrauterine System [Mirena]
74 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 | 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 |
| 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 |
| 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 |
| Community Care's Partnership Program (HMO D-SNP) | COMMUNITY CARE HEALTH PLAN, INC. | T1 | No | $0 | WI |
| Platino Blindao (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| PLATINO ADVANCE (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| PLATINO PLUS (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| 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 |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK HEALTH OPTIONS WEST VIRGINIA INC. | T1 | No | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | No | $0 | DE |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T1 | No | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | TEXAS INDEPENDENCE HEALTH PLAN, INC. | T1 | No | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | TEXAS INDEPENDENCE HEALTH PLAN, INC. | T1 | No | $4.80 | TX |
| Tribute Select (HMO-POS I-SNP) | ARKANSAS SUPERIOR SELECT, INC. | T1 | No | $8.90 | AR |
| ATRIO Special Needs Plan (HMO D-SNP) | ATRIO HEALTH PLANS | T1 | No | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | ATRIO HEALTH PLANS | T1 | No | $10.50 | OR |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $13.10 | PA |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T1 | No | $17.00 | AZ |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $17.60 | PA |
| Alterwood Advantage Dual Value (HMO D-SNP) | ALTERWOOD ADVANTAGE, INC. | T1 | No | $31.20 | MD |
| Highmark Health Options Duals Select (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | No | $31.20 | DE |
| Valor Health Plan (HMO I-SNP) | TSG GUARD, INC. | T1 | No | $31.40 | OH |
| WV Senior Advantage (HMO I-SNP) | WEST VIRGINIA SENIOR ADVANTAGE, INC. | T1 | No | $32.70 | WV |
| Abilis Health (HMO I-SNP) | SIGNATURE ADVANTAGE, LLC | T1 | No | $35.90 | KY, TN |
| CommuniCare Advantage ISNP (HMO I-SNP) | OH CHS SNP INC. | T1 | No | $38.40 | IN, MD, OH |
| Nascentia Skilled Nursing Facility (HMO I-SNP) | VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK | T1 | No | $58.80 | NY |
| CareAdvantage (HMO D-SNP) | SAN MATEO HEALTH COMMISSION | T2 | No | $0 | CA |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | No | $0 | CA |
| HealthPartners Minnesota Senior Health Options (HMO D-SNP) | HEALTHPARTNERS, INC. | T3 | No | $0 | MN |
| HealthPartners Journey Pace (PPO) | HEALTHPARTNERS, INC. | T3 | No | $0 | MN |
| HealthPartners Journey Smart (PPO) | HEALTHPARTNERS, INC. | T3 | No | $0 | MN |
| HealthPartners Birch (PPO) | HEALTHPARTNERS INSURANCE COMPANY | T3 | No | $0 | WI |
| HealthPartners Cedar (PPO) | HEALTHPARTNERS INSURANCE COMPANY | T3 | No | $0 | WI |
| Regence MedAdvantage + Rx Primary (PPO) | REGENCE BLUECROSS BLUESHIELD OF OREGON | T3 | No | $0 | OR, WA |
| Regence BlueAdvantage HMO (HMO) | REGENCE BLUECROSS BLUESHIELD OF OREGON | T3 | No | $0 | OR |
| PHP (HMO C-SNP) | AIDS HEALTHCARE FOUNDATION | T3 | No | $0 | CA |
| DualConnect (HMO D-SNP) | SANTA CLARA COUNTY HEALTH AUTHORITY | T3 | No | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS CHOICE | T3 | No | $0 | NY |
Frequently Asked Questions
Is levonorgestrel 0.000833 MG/HR Intrauterine System [Mirena] covered by Medicare Part D?
Yes, levonorgestrel 0.000833 MG/HR Intrauterine System [Mirena] is covered by 1,214 Medicare Part D plans (24% of all Part D formularies).
What tier is levonorgestrel 0.000833 MG/HR Intrauterine System [Mirena] on Medicare Part D plans?
levonorgestrel 0.000833 MG/HR Intrauterine System [Mirena] averages Tier 3.1 across Part D plans, ranging from Tier 1 to Tier 4.
Does levonorgestrel 0.000833 MG/HR Intrauterine System [Mirena] require prior authorization?
3.3% of Part D formularies require prior authorization for levonorgestrel 0.000833 MG/HR Intrauterine System [Mirena]. Step therapy: 0%. Quantity limits: 3.3%.
How much does Medicare spend on levonorgestrel 0.000833 MG/HR Intrauterine System [Mirena]?
In 2023, total Medicare Part D spending on levonorgestrel 0.000833 MG/HR Intrauterine System [Mirena] 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.
Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare Editorial