lisdexamfetamine dimesylate 20 MG Oral Capsule [Vyvanse]
lisdexamfetamine dimesylate
RxCUI: 854832
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.