Medicare Part D coverage · levonorgestrel · RxCUI 807283
levonorgestrel 0.000833 MG/HR Intrauterine System [Mirena]
Per the CMS 2026 Part D formulary file, levonorgestrel 0.000833 MG/HR Intrauterine System [Mirena] is covered by 1,213 Medicare Part D plans (24% of enrollable products), averaging Tier 3.1, with prior authorization required on 3.3% of covering formularies.
- 24%
- Plan coverage
- 1,213
- 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 1,213 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
- 1,213
- 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
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 | - |
Show the next 6 plans
| 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 |
Show the next 30 plans
| 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 |
Showing top 50 of 74 plans.
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 1,213 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.
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
Similar prior-authorization rate
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