lomustine 100 MG Oral Capsule [Gleostine]
lomustine
RxCUI: 1545778
What the CMS Formulary Data Shows for lomustine 100 MG Oral Capsule [Gleostine]
Per the CMS 2026 Part D formulary file, lomustine 100 MG Oral Capsule [Gleostine] (RxNorm concept RXCUI 1545778, generic name lomustine) appears on 138 distinct formulary files spanning 3,560 Medicare Part D plan offerings - 70.3% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.3.
Real-world access to lomustine 100 MG Oral Capsule [Gleostine] depends on utilization management as much as tier placement: 10.1% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 662 Part D beneficiaries filled lomustine 100 MG Oral Capsule [Gleostine] in 2023, with total plan-and-beneficiary spending of $2,702,189 and an average per-beneficiary annual cost of $4,081.86. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry lomustine 100 MG Oral Capsule [Gleostine] today.
Coverage Details
- Formularies covering
- 138
- Plans covering
- 3,560
- Coverage rate
- 70.3%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 10.1% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 662
- Total spending
- $2,702,189
- Avg per beneficiary
- $4,081.86
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering lomustine 100 MG Oral Capsule [Gleostine]
11 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
| CarePartners Access (PPO) | CAREPARTNERS OF CONNECTICUT, INC. | T4 | No | No | $0 | CT |
| CarePartners of CT CareAdvantage Preferred (HMO) | CAREPARTNERS OF CONNECTICUT, INC. | T4 | No | No | $0 | CT |
Medicare Advantage Plans (MA-PD) Covering lomustine 100 MG Oral Capsule [Gleostine]
89 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | HPMP OF FLORIDA, INC. | T1 | No | $0 | FL |
| ElderServe MAP (HMO D-SNP) | ELDERSERVE HEALTH, INC. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | GROUP HEALTH COOPERATIVE OF EAU CLAIRE | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP | T1 | No | $0 | NJ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | ELDERPLAN, INC. | T1 | No | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | HEALTH CHOICE ARIZONA, INC. | T1 | No | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | HEALTHFIRST HEALTH PLAN, INC. | T1 | No | $0 | NY |
| IMCare Classic (HMO D-SNP) | ITASCA MEDICAL CARE | T1 | No | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | HOPKINS HEALTH ADVANTAGE, INC. | T1 | No | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | METROPLUS HEALTH PLAN, INC. | T1 | No | $0 | NY |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | UPPER PENINSULA HEALTH PLAN, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | CARESOURCE GEORGIA CO. | T1 | No | $0 | GA |
| Senior Whole Health SCO (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| Molina One Care (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP CARESOURCE | T1 | No | $0 | MI |
| NaviCare (HMO D-SNP) | FALLON COMMUNITY HEALTH PLAN | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| CCA One Care (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | T1 | No | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | T1 | No | $0 | MA |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $0 | IN |
| Provider Partners Maryland Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $0 | MD |
| Provider Partners Missouri Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $0 | MO |
| Platino Blindao (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| PLATINO ADVANCE (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| PLATINO PLUS (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| Tufts Health One Care (HMO D-SNP) | TUFTS HEALTH PUBLIC PLANS, INC. | T1 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | TUFTS HEALTH PUBLIC PLANS, INC. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION | T1 | No | $0 | MA |
| Florida Complete Care (HMO I-SNP) | HPMP OF FLORIDA, INC. | T1 | No | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | HPMP OF FLORIDA, INC. | T1 | No | $4.80 | FL |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF FLORIDA, INC. | T1 | No | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC. | T1 | No | $4.80 | TX |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF MICHIGAN, INC. | T1 | No | $8.80 | MI |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF ILLINOIS, INC. | T1 | No | $15.20 | IL |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS | T1 | No | $15.20 | IL |
| WellSense Added Value (HMO) | BOSTON MEDICAL CENTER HEALTH PLAN, INC. | T1 | No | $21.70 | NH |
| Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) | ELDERPLAN, INC. | T1 | No | $22.70 | NY |
| VIVA Medicare Extra Value (HMO D-SNP) | VIVA HEALTH, INC. | T1 | No | $27.70 | AL |
| VIVA Medicare Extra Care (HMO D-SNP) | VIVA HEALTH, INC. | T1 | No | $27.70 | AL |
| Provider Partners Maryland Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $31.20 | MD |
| Provider Partners Maryland Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $31.20 | MD |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $32.70 | PA |
Frequently Asked Questions
Is lomustine 100 MG Oral Capsule [Gleostine] covered by Medicare Part D?
Yes, lomustine 100 MG Oral Capsule [Gleostine] is covered by 3,560 Medicare Part D plans (70.3% of all Part D formularies).
What tier is lomustine 100 MG Oral Capsule [Gleostine] on Medicare Part D plans?
lomustine 100 MG Oral Capsule [Gleostine] averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 5.
Does lomustine 100 MG Oral Capsule [Gleostine] require prior authorization?
10.1% of Part D formularies require prior authorization for lomustine 100 MG Oral Capsule [Gleostine]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on lomustine 100 MG Oral Capsule [Gleostine]?
In 2023, total Medicare Part D spending on lomustine 100 MG Oral Capsule [Gleostine] was $2,702,189, covering 662 beneficiaries. The average spend per beneficiary was $4,081.86.
Read our methodology - how this data is sourced, computed, and verified.