levothyroxine sodium 0.025 MG/ML Oral Solution [Tirosint]
levothyroxine sodium
RxCUI: 2056466
What the CMS Formulary Data Shows for levothyroxine sodium 0.025 MG/ML Oral Solution [Tirosint]
Per the CMS 2026 Part D formulary file, levothyroxine sodium 0.025 MG/ML Oral Solution [Tirosint] (RxNorm concept RXCUI 2056466, generic name levothyroxine sodium) appears on 9 distinct formulary files spanning 48 Medicare Part D plan offerings - 0.9% 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 0.025 MG/ML Oral Solution [Tirosint] depends on utilization management as much as tier placement: 11.1% of covering formularies require prior authorization. 0% require step therapy. 11.1% 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 0.025 MG/ML Oral Solution [Tirosint] 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 0.025 MG/ML Oral Solution [Tirosint] today.
Coverage Details
- Formularies covering
- 9
- Plans covering
- 48
- Coverage rate
- 0.9%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 11.1% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 11.1% 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 0.025 MG/ML Oral Solution [Tirosint]
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 0.025 MG/ML Oral Solution [Tirosint]
46 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $34.50 | NY |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | No | $0 | CA |
| Leon MediExtra (HMO) | LEON HEALTH, INC. | T2 | No | $0 | FL |
| Leon MediDual (HMO D-SNP) | LEON HEALTH, INC. | T2 | No | $0 | FL |
| Leon MediMore (HMO) | LEON HEALTH, INC. | T2 | No | $0 | FL |
| Leon MediMax (HMO D-SNP) | LEON HEALTH, INC. | T2 | No | $0 | FL |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T3 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | UT |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | NV |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | CO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | CO |
| Select Health Medicare Flex (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | CO |
| Select Health Medicare Active (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T3 | No | $0 | NV |
| Select Health Medicare Wellness (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | NV |
| Healthy Mississippi Premier Advantage (HMO-POS) | Healthy Mississippi, Inc. | T3 | No | $0 | MS |
| 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 |
| CareOregon Advantage Plus (HMO D-SNP) | HEALTH PLAN OF CAREOREGON, INC. | T4 | Yes | $0 | OR |
| 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 |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | No | $47.00 | PA |
| Security Blue HMO-POS Standard (HMO-POS) | HIGHMARK CHOICE COMPANY | T4 | No | $51.80 | PA |
| Keystone 65 Preferred Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | No | $59.70 | PA |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | No | $63.50 | PA |
| Keystone 65 Preferred Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | No | $79.70 | 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 |
| Personal Choice 65 Rx (PPO) | QCC INSURANCE COMPANY | T4 | No | $102.20 | PA |
| Personal Choice 65 Rx (PPO) | QCC INSURANCE COMPANY | T4 | No | $112.70 | 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 0.025 MG/ML Oral Solution [Tirosint] covered by Medicare Part D?
Yes, levothyroxine sodium 0.025 MG/ML Oral Solution [Tirosint] is covered by 48 Medicare Part D plans (0.9% of all Part D formularies).
What tier is levothyroxine sodium 0.025 MG/ML Oral Solution [Tirosint] on Medicare Part D plans?
levothyroxine sodium 0.025 MG/ML Oral Solution [Tirosint] averages Tier 3 across Part D plans, ranging from Tier 1 to Tier 4.
Does levothyroxine sodium 0.025 MG/ML Oral Solution [Tirosint] require prior authorization?
11.1% of Part D formularies require prior authorization for levothyroxine sodium 0.025 MG/ML Oral Solution [Tirosint]. Step therapy: 0%. Quantity limits: 11.1%.
How much does Medicare spend on levothyroxine sodium 0.025 MG/ML Oral Solution [Tirosint]?
In 2023, total Medicare Part D spending on levothyroxine sodium 0.025 MG/ML Oral Solution [Tirosint] 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.