levothyroxine sodium 0.112 MG Oral Capsule
levothyroxine sodium
RxCUI: 905451
What the CMS Formulary Data Shows for levothyroxine sodium 0.112 MG Oral Capsule
Per the CMS 2026 Part D formulary file, levothyroxine sodium 0.112 MG Oral Capsule (RxNorm concept RXCUI 905451, generic name levothyroxine sodium) appears on 3 distinct formulary files spanning 20 Medicare Part D plan offerings - 0.4% 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.
Real-world access to levothyroxine sodium 0.112 MG Oral Capsule depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 8,687,969 Part D beneficiaries filled levothyroxine sodium 0.112 MG Oral Capsule in 2023, with total plan-and-beneficiary spending of $653,594,902 and an average per-beneficiary annual cost of $75.23. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry levothyroxine sodium 0.112 MG Oral Capsule today.
Coverage Details
- Formularies covering
- 3
- Plans covering
- 20
- Coverage rate
- 0.4%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 8,687,969
- Total spending
- $653,594,902
- Avg per beneficiary
- $75.23
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering levothyroxine sodium 0.112 MG Oral Capsule
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP) | HM HEALTH INSURANCE COMPANY | T4 | No | No | $164.80 | - |
| Blue Rx PDP Plus (PDP) | HM HEALTH INSURANCE COMPANY | T4 | No | No | $193.20 | - |
Medicare Advantage Plans (MA-PD) Covering levothyroxine sodium 0.112 MG Oral Capsule
18 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T1 | No | $0 | CA |
| DrMax (HMO) | DOCTORS HEALTHCARE PLANS, INC. | T4 | No | $0 | FL |
| DrExtraCare (HMO C-SNP) | DOCTORS HEALTHCARE PLANS, INC. | T4 | No | $0 | FL |
| DrSelect (HMO) | DOCTORS HEALTHCARE PLANS, INC. | T4 | No | $0 | FL |
| DrSelect-CFL (HMO) | DOCTORS HEALTHCARE PLANS, INC. | T4 | No | $0 | FL |
| DrPlatinum-CFL (HMO D-SNP) | DOCTORS HEALTHCARE PLANS, INC. | T4 | No | $0 | FL |
| DrTotalCare-CFL (HMO C-SNP) | DOCTORS HEALTHCARE PLANS, INC. | T4 | No | $0 | FL |
| DrElite-SFL (HMO) | DOCTORS HEALTHCARE PLANS, INC. | T4 | No | $0 | FL |
| DrFlex (HMO D-SNP) | DOCTORS HEALTHCARE PLANS, INC. | T4 | No | $1.10 | FL |
| DrPlus (HMO D-SNP) | DOCTORS HEALTHCARE PLANS, INC. | T4 | No | $4.80 | FL |
| Security Blue HMO-POS Standard (HMO-POS) | HIGHMARK CHOICE COMPANY | T4 | No | $51.80 | PA |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $95.70 | PA |
| Security Blue HMO-POS Deluxe (HMO-POS) | HIGHMARK CHOICE COMPANY | T4 | No | $95.90 | PA |
| Freedom Blue PPO Standard (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $98.20 | PA |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $115.70 | PA |
| Freedom Blue PPO Deluxe (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $122.40 | PA |
| Freedom Blue PPO Classic (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $140.90 | PA |
| Freedom Blue PPO Classic (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $145.40 | PA |
Frequently Asked Questions
Is levothyroxine sodium 0.112 MG Oral Capsule covered by Medicare Part D?
Yes, levothyroxine sodium 0.112 MG Oral Capsule is covered by 20 Medicare Part D plans (0.4% of all Part D formularies).
What tier is levothyroxine sodium 0.112 MG Oral Capsule on Medicare Part D plans?
levothyroxine sodium 0.112 MG Oral Capsule averages Tier 3 across Part D plans, ranging from Tier 1 to Tier 4.
Does levothyroxine sodium 0.112 MG Oral Capsule require prior authorization?
0% of Part D formularies require prior authorization for levothyroxine sodium 0.112 MG Oral Capsule. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on levothyroxine sodium 0.112 MG Oral Capsule?
In 2023, total Medicare Part D spending on levothyroxine sodium 0.112 MG Oral Capsule was $653,594,902, covering 8,687,969 beneficiaries. The average spend per beneficiary was $75.23.
Read our methodology - how this data is sourced, computed, and verified.