Medicare Part D coverage · megestrol acetate · RxCUI 860225
megestrol acetate 40 MG/ML Oral Suspension
Per the CMS 2026 Part D formulary file, megestrol acetate 40 MG/ML Oral Suspension is covered by 5,052 Medicare Part D plans (100% of enrollable products), averaging Tier 2.6, with prior authorization required on 40.9% of covering formularies.
- 100%
- Plan coverage
- 5,052
- Plans covering
- T2.6
- Avg tier
- 40.9%
- Prior auth required
What the CMS Formulary Data Shows for megestrol acetate 40 MG/ML Oral Suspension
Per the CMS 2026 Part D formulary file, megestrol acetate 40 MG/ML Oral Suspension (RxNorm concept RXCUI 860225, generic name megestrol acetate) appears on 328 distinct formulary files spanning 5,052 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 2.6.
Real-world access to megestrol acetate 40 MG/ML Oral Suspension depends on utilization management as much as tier placement: 40.9% 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/ML Oral Suspension 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/ML Oral Suspension today.
Coverage Details
- Formularies covering
- 328
- Plans covering
- 5,052
- Coverage rate
- 100%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 40.9% 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/ML Oral Suspension
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 |
Show the next 30 plans
| 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 |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is megestrol acetate 40 MG/ML Oral Suspension covered by Medicare Part D?
Yes, megestrol acetate 40 MG/ML Oral Suspension is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).
What tier is megestrol acetate 40 MG/ML Oral Suspension on Medicare Part D plans?
megestrol acetate 40 MG/ML Oral Suspension averages Tier 2.6 across Part D plans, ranging from Tier 1 to Tier 4.
Does megestrol acetate 40 MG/ML Oral Suspension require prior authorization?
40.9% of Part D formularies require prior authorization for megestrol acetate 40 MG/ML Oral Suspension. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on megestrol acetate 40 MG/ML Oral Suspension?
In 2023, total Medicare Part D spending on megestrol acetate 40 MG/ML Oral Suspension 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.
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
- voriconazole 200 MG Oral Tablet 40.9% PA
- tacrolimus 0.0003 MG/MG Topical Ointment 40.9% PA
- 8 HR methylphenidate hydrochloride 10 MG Extended Release Oral Tablet 41% PA
- voriconazole 50 MG Oral Tablet 40.7% PA
- lactulose 10000 MG Powder for Oral Solution 41.2% PA
- prednisone 5 MG/ML Oral Solution 41.2% PA