lisdexamfetamine dimesylate 50 MG Oral Capsule
lisdexamfetamine dimesylate
RxCUI: 854850
What the CMS Formulary Data Shows for lisdexamfetamine dimesylate 50 MG Oral Capsule
Per the CMS 2026 Part D formulary file, lisdexamfetamine dimesylate 50 MG Oral Capsule (RxNorm concept RXCUI 854850, generic name lisdexamfetamine dimesylate) appears on 100 distinct formulary files spanning 2,329 Medicare Part D plan offerings - 46% 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 lisdexamfetamine dimesylate 50 MG Oral Capsule depends on utilization management as much as tier placement: 15% of covering formularies require prior authorization. 3% require step therapy. 64% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 57,529 Part D beneficiaries filled lisdexamfetamine dimesylate 50 MG Oral Capsule in 2023, with total plan-and-beneficiary spending of $138,990,768 and an average per-beneficiary annual cost of $2,416.01. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry lisdexamfetamine dimesylate 50 MG Oral Capsule today.
Coverage Details
- Formularies covering
- 100
- Plans covering
- 2,329
- Coverage rate
- 46%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 15% of formularies
- Step therapy required
- 3% of formularies
- Quantity limits
- 64% of formularies
2023 Medicare Spending
- Beneficiaries
- 57,529
- Total spending
- $138,990,768
- Avg per beneficiary
- $2,416.01
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering lisdexamfetamine dimesylate 50 MG Oral Capsule
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| CareAdvantage (HMO D-SNP) | SAN MATEO HEALTH COMMISSION | T1 | No | $0 | CA |
| 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 |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | No | $0 | MN |
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| 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 |
| Senior Care (HMO I-SNP) | ALIGN SENIOR CARE FLORIDA, INC. | T1 | No | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | PROCARE ADVANTAGE, LLC | T1 | No | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | PROCARE ADVANTAGE, LLC | T1 | No | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | AMERICAN HEALTH PLAN OF FL, INC. | T1 | No | $4.80 | FL |
| SECUR Advantage (HMO I-SNP) | SECUR INC | T1 | No | $4.80 | FL |
| SECUR Enhanced (HMO I-SNP) | SECUR INC | T1 | No | $4.80 | FL |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | HCSC INSURANCE SERVICES COMPANY | T1 | No | $4.80 | TX |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS INSURANCE COMPANY | T1 | No | $5.00 | OK |
| Senior Care (HMO I-SNP) | ALIGN SENIOR CARE MI, LLC | T1 | No | $8.80 | MI |
| AgeRight Advantage Health Plan (HMO I-SNP) | MARQUIS ADVANTAGE, INC. | T1 | No | $10.50 | OR, WA |
| Senior Care (HMO I-SNP) | ALIGN SENIOR CARE CALIFORNIA INC. | T1 | No | $12.00 | CA |
| Liberty Medicare Dual Plan (HMO D-SNP) | LIBERTY ADVANTAGE, LLC | T1 | No | $14.70 | NC |
| KeyCare Advantage (HMO I-SNP) | ISNP VENTURES, LLC | T1 | No | $23.20 | MD |
| American Health Advantage of Mississippi (HMO I-SNP) | AMERICAN HEALTH PLAN OF MS, INC. | T1 | No | $23.80 | MS |
| Senior Care (HMO I-SNP) | LIFEWORKS ADVANTAGE, LLC | T1 | No | $24.60 | VA |
| PruittHealth Premier (HMO I-SNP) | PRUITTHEALTH PREMIER, INC. | T1 | No | $25.40 | GA |
| Georgia Health Advantage (HMO I-SNP) | GEORGIA ASSURANCE, INC. | T1 | No | $25.40 | GA |
| Georgia Health Advantage Choice (HMO I-SNP) | GEORGIA ASSURANCE, INC. | T1 | No | $25.40 | GA |
| American Health Advantage of Tennessee (HMO I-SNP) | AMERICAN HEALTH PLAN, INC. | T1 | No | $27.70 | TN |
| Simpra Advantage Nursing Home Plan (PPO I-SNP) | SIMPRA ADVANTAGE, INC. | T1 | No | $27.70 | AL |
| American Health Advantage of Oklahoma (HMO I-SNP) | OKLAHOMA SUPERIOR SELECT, INC. | T1 | No | $28.20 | OK |
| NHC Advantage (HMO I-SNP) | NHC ADVANTAGE, LLC | T1 | No | $31.00 | MO, NC, SC, TN |
| Perennial Advantage Strive (HMO I-SNP) | PERENNIAL ADVANTAGE OF OHIO, INC. | T1 | No | $31.40 | OH |
| Perennial Advantage Strive (HMO I-SNP) | PERENNIAL ADVANTAGE OF COLORADO, INC. | T1 | No | $32.70 | PA |
| American Health Advantage of Pennsylvania (HMO I-SNP) | AMERICAN HEALTH PLAN OF PENNSYLVANIA INC | T1 | No | $32.70 | PA |
| Lagniappe Advantage (PPO I-SNP) | LAGNIAPPE ADVANTAGE INSURANCE COMPANY | T1 | No | $32.90 | LA |
| American Health Advantage of Louisiana (HMO I-SNP) | DIGNITY CARE CORPORATION | T1 | No | $32.90 | LA |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $34.50 | NY |
| Perennial Advantage Strive (HMO I-SNP) | PERENNIAL ADVANTAGE OF COLORADO, INC. | T1 | No | $35.20 | CO |
| PruittHealth Premier (HMO I-SNP) | PRUITTHEALTH PREMIER NORTH CAROLINA, LLC | T1 | No | $35.70 | SC |
| PruittHealth Premier (HMO I-SNP) | PRUITTHEALTH PREMIER NORTH CAROLINA, LLC | T1 | No | $36.20 | NC |
| Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) | LIBERTY ADVANTAGE, LLC | T1 | No | $36.20 | NC |
| American Health Advantage of Utah (HMO I-SNP) | AMERICAN HEALTH PLAN OF UT, INC. | T1 | No | $37.60 | UT |
| American Health Advantage of Idaho (HMO I-SNP) | AMERICAN HEALTH PLAN OF UT, INC. | T1 | No | $37.60 | ID |
| American Health Advantage of Indiana (HMO I-SNP) | AMERICAN HEALTH PLAN OF INDIANA INC | T1 | No | $38.40 | IN |
| Iowa Health Advantage (HMO I-SNP) | AMERICAN HEALTH PLAN OF IOWA INC | T1 | No | $41.50 | IA |
| Iowa Health Advantage Choice (HMO I-SNP) | AMERICAN HEALTH PLAN OF IOWA INC | T1 | No | $41.50 | IA |
| American Health Advantage of Missouri (HMO I-SNP) | AMERICAN HEALTH PLAN OF MISSOURI, INC. | T1 | No | $43.00 | MO |
| American Health Advantage of Missouri Choice (HMO I-SNP) | AMERICAN HEALTH PLAN OF MISSOURI, INC. | T1 | No | $43.00 | MO |
| Kansas Health Advantage (HMO I-SNP) | KANSAS SUPERIOR SELECT, INC. | T1 | No | $55.20 | KS |
Frequently Asked Questions
Is lisdexamfetamine dimesylate 50 MG Oral Capsule covered by Medicare Part D?
Yes, lisdexamfetamine dimesylate 50 MG Oral Capsule is covered by 2,329 Medicare Part D plans (46% of all Part D formularies).
What tier is lisdexamfetamine dimesylate 50 MG Oral Capsule on Medicare Part D plans?
lisdexamfetamine dimesylate 50 MG Oral Capsule averages Tier 3 across Part D plans, ranging from Tier 1 to Tier 4.
Does lisdexamfetamine dimesylate 50 MG Oral Capsule require prior authorization?
15% of Part D formularies require prior authorization for lisdexamfetamine dimesylate 50 MG Oral Capsule. Step therapy: 3%. Quantity limits: 64%.
How much does Medicare spend on lisdexamfetamine dimesylate 50 MG Oral Capsule?
In 2023, total Medicare Part D spending on lisdexamfetamine dimesylate 50 MG Oral Capsule was $138,990,768, covering 57,529 beneficiaries. The average spend per beneficiary was $2,416.01.
Read our methodology - how this data is sourced, computed, and verified.