megestrol acetate 40 MG Oral Tablet
megestrol acetate
RxCUI: 860221
What the CMS Formulary Data Shows for megestrol acetate 40 MG Oral Tablet
Per the CMS 2026 Part D formulary file, megestrol acetate 40 MG Oral Tablet (RxNorm concept RXCUI 860221, generic name megestrol acetate) appears on 330 distinct formulary files spanning 5,067 Medicare Part D plan offerings - 100% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.2.
Real-world access to megestrol acetate 40 MG Oral Tablet depends on utilization management as much as tier placement: 37.6% 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 168,919 Part D beneficiaries filled megestrol acetate 40 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $35,381,780 and an average per-beneficiary annual cost of $209.46. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry megestrol acetate 40 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 330
- Plans covering
- 5,067
- Coverage rate
- 100%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 37.6% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 168,919
- Total spending
- $35,381,780
- Avg per beneficiary
- $209.46
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering megestrol acetate 40 MG Oral Tablet
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | SENTARA HEALTH PLANS | T1 | Yes | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | SENTARA HEALTH PLANS | T1 | Yes | $0 | VA |
| HealthSun HealthAdvantage Plan (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun MediMax (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun MediSun Plus (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun MediSun Extra (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun MediSun Full Dual Plus (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun MediSun Full Dual Extra (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Extra (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply More Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Complete Platinum (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply More Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Complete Platinum (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
Frequently Asked Questions
Is megestrol acetate 40 MG Oral Tablet covered by Medicare Part D?
Yes, megestrol acetate 40 MG Oral Tablet is covered by 5,067 Medicare Part D plans (100% of all Part D formularies).
What tier is megestrol acetate 40 MG Oral Tablet on Medicare Part D plans?
megestrol acetate 40 MG Oral Tablet averages Tier 2.2 across Part D plans, ranging from Tier 1 to Tier 4.
Does megestrol acetate 40 MG Oral Tablet require prior authorization?
37.6% of Part D formularies require prior authorization for megestrol acetate 40 MG Oral Tablet. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on megestrol acetate 40 MG Oral Tablet?
In 2023, total Medicare Part D spending on megestrol acetate 40 MG Oral Tablet was $35,381,780, covering 168,919 beneficiaries. The average spend per beneficiary was $209.46.
Read our methodology - how this data is sourced, computed, and verified.