Medicare Part D coverage · lisdexamfetamine dimesylate · RxCUI 854832
lisdexamfetamine dimesylate 20 MG Oral Capsule [Vyvanse]
Per the CMS 2026 Part D formulary file, lisdexamfetamine dimesylate 20 MG Oral Capsule [Vyvanse] is covered by 12 Medicare Part D plans (0.2% of enrollable products), averaging Tier 2.5, with prior authorization required on 50% of covering formularies.
- 0.2%
- Plan coverage
- 12
- Plans covering
- T2.5
- Avg tier
- 50%
- Prior auth required
What the CMS Formulary Data Shows for lisdexamfetamine dimesylate 20 MG Oral Capsule [Vyvanse]
Per the CMS 2026 Part D formulary file, lisdexamfetamine dimesylate 20 MG Oral Capsule [Vyvanse] (RxNorm concept RXCUI 854832, generic name lisdexamfetamine dimesylate) appears on 2 distinct formulary files spanning 12 Medicare Part D plan offerings - 0.2% 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 2.5.
Real-world access to lisdexamfetamine dimesylate 20 MG Oral Capsule [Vyvanse] depends on utilization management as much as tier placement: 50% of covering formularies require prior authorization. 0% require step therapy. 100% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 57,529 Part D beneficiaries filled lisdexamfetamine dimesylate 20 MG Oral Capsule [Vyvanse] 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 20 MG Oral Capsule [Vyvanse] today.
Coverage Details
- Formularies covering
- 2
- Plans covering
- 12
- Coverage rate
- 0.2%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 50% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 100% 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 20 MG Oral Capsule [Vyvanse]
12 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 |
| Health First Rewards H1099-014 (HMO) | Health First Health Plans | T4 | Yes | $0 | FL |
| Health First SunSaver H1099-016 (HMO) | Health First Health Plans | T4 | Yes | $0 | FL |
| Health First Complete Care H1099-023 (HMO) | Health First Health Plans | T4 | Yes | $0 | FL |
| Health First Emerald Plus H1099-024 (HMO) | Health First Health Plans | T4 | Yes | $0 | FL |
| Health First Premier Access H1099-025 (HMO-POS) | Health First Health Plans | T4 | Yes | $0 | FL |
| Health First Emerald Plus H1099-026 (HMO) | Health First Health Plans | T4 | Yes | $0 | FL |
| Health First Premier Access H1099-027 (HMO-POS) | Health First Health Plans | T4 | Yes | $0 | FL |
| Health First Emerald Plus H1099-028 (HMO) | Health First Health Plans | T4 | Yes | $0 | FL |
| Health First Value H1099-006 (HMO) | Health First Health Plans | T4 | Yes | $15.00 | FL |
| Health First Classic H1099-001 (HMO-POS) | Health First Health Plans | T4 | Yes | $49.40 | FL |
Frequently Asked Questions
Is lisdexamfetamine dimesylate 20 MG Oral Capsule [Vyvanse] covered by Medicare Part D?
Yes, lisdexamfetamine dimesylate 20 MG Oral Capsule [Vyvanse] is covered by 12 Medicare Part D plans (0.2% of all Part D formularies).
What tier is lisdexamfetamine dimesylate 20 MG Oral Capsule [Vyvanse] on Medicare Part D plans?
lisdexamfetamine dimesylate 20 MG Oral Capsule [Vyvanse] averages Tier 2.5 across Part D plans, ranging from Tier 1 to Tier 4.
Does lisdexamfetamine dimesylate 20 MG Oral Capsule [Vyvanse] require prior authorization?
50% of Part D formularies require prior authorization for lisdexamfetamine dimesylate 20 MG Oral Capsule [Vyvanse]. Step therapy: 0%. Quantity limits: 100%.
How much does Medicare spend on lisdexamfetamine dimesylate 20 MG Oral Capsule [Vyvanse]?
In 2023, total Medicare Part D spending on lisdexamfetamine dimesylate 20 MG Oral Capsule [Vyvanse] 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.
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
- 0.2 ML adalimumab-atto 50 MG/ML Prefilled Syringe [Amjevita] 50% PA
- prednisolone 15 MG Disintegrating Oral Tablet [Orapred] 50% PA
- trazodone hydrochloride 10 MG/ML Oral Solution [Raldesy] 50% PA
- lactulose 20000 MG Powder for Oral Solution 50% PA
- memantine hydrochloride 10 MG Oral Tablet 50% PA
- 168 HR estradiol 0.00104 MG/HR Transdermal System [Climara] 50% PA