Medicare Part D coverage · lisdexamfetamine dimesylate · RxCUI 1593856
lisdexamfetamine dimesylate 10 MG Oral Capsule
Per the CMS 2026 Part D formulary file, lisdexamfetamine dimesylate 10 MG Oral Capsule is covered by 2,327 Medicare Part D plans (46.1% of enrollable products), averaging Tier 3, with prior authorization required on 15.2% of covering formularies.
- 46.1%
- Plan coverage
- 2,327
- Plans covering
- T3
- Avg tier
- 15.2%
- Prior auth required
What the CMS Formulary Data Shows for lisdexamfetamine dimesylate 10 MG Oral Capsule
Per the CMS 2026 Part D formulary file, lisdexamfetamine dimesylate 10 MG Oral Capsule (RxNorm concept RXCUI 1593856, generic name lisdexamfetamine dimesylate) appears on 99 distinct formulary files spanning 2,327 Medicare Part D plan offerings - 46.1% 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 10 MG Oral Capsule depends on utilization management as much as tier placement: 15.2% of covering formularies require prior authorization. 3% require step therapy. 64.6% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 57,529 Part D beneficiaries filled lisdexamfetamine dimesylate 10 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 10 MG Oral Capsule today.
Coverage Details
- Formularies covering
- 99
- Plans covering
- 2,327
- Coverage rate
- 46.1%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 15.2% of formularies
- Step therapy required
- 3% of formularies
- Quantity limits
- 64.6% 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 10 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 |
Show the next 30 plans
| 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 |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is lisdexamfetamine dimesylate 10 MG Oral Capsule covered by Medicare Part D?
Yes, lisdexamfetamine dimesylate 10 MG Oral Capsule is covered by 2,327 Medicare Part D plans (46.1% of all Part D formularies).
What tier is lisdexamfetamine dimesylate 10 MG Oral Capsule on Medicare Part D plans?
lisdexamfetamine dimesylate 10 MG Oral Capsule averages Tier 3 across Part D plans, ranging from Tier 1 to Tier 4.
Does lisdexamfetamine dimesylate 10 MG Oral Capsule require prior authorization?
15.2% of Part D formularies require prior authorization for lisdexamfetamine dimesylate 10 MG Oral Capsule. Step therapy: 3%. Quantity limits: 64.6%.
How much does Medicare spend on lisdexamfetamine dimesylate 10 MG Oral Capsule?
In 2023, total Medicare Part D spending on lisdexamfetamine dimesylate 10 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.
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
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