octreotide 20 MG Delayed Release Oral Capsule [Mycapssa]
octreotide
RxCUI: 2380617
What the CMS Formulary Data Shows for octreotide 20 MG Delayed Release Oral Capsule [Mycapssa]
Per the CMS 2026 Part D formulary file, octreotide 20 MG Delayed Release Oral Capsule [Mycapssa] (RxNorm concept RXCUI 2380617, generic name octreotide) appears on 6 distinct formulary files spanning 15 Medicare Part D plan offerings - 0.3% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 3.7.
Real-world access to octreotide 20 MG Delayed Release Oral Capsule [Mycapssa] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 33.3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 3,041 Part D beneficiaries filled octreotide 20 MG Delayed Release Oral Capsule [Mycapssa] in 2023, with total plan-and-beneficiary spending of $6,271,034 and an average per-beneficiary annual cost of $2,062.16. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry octreotide 20 MG Delayed Release Oral Capsule [Mycapssa] today.
Coverage Details
- Formularies covering
- 6
- Plans covering
- 15
- Coverage rate
- 0.3%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 33.3% of formularies
2023 Medicare Spending
- Beneficiaries
- 3,041
- Total spending
- $6,271,034
- Avg per beneficiary
- $2,062.16
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering octreotide 20 MG Delayed Release Oral Capsule [Mycapssa]
15 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Mass General Brigham SCO (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | Yes | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | Yes | $0 | MA |
| Mass General Brigham Advantage (PPO) | Mass General Brigham Health Plan, Inc. | T5 | Yes | $0 | MA |
| CareOregon Advantage Plus (HMO D-SNP) | HEALTH PLAN OF CAREOREGON, INC. | T5 | Yes | $0 | OR |
| UPMC for Life HMO Rx Choice (HMO) | UPMC HEALTH PLAN, INC. | T5 | Yes | $3.90 | OH, PA |
| UPMC for Life HMO Deductible Rx (HMO) | UPMC HEALTH PLAN, INC. | T5 | Yes | $18.10 | OH, PA |
| UPMC for Life PPO Rx Choice (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $25.00 | PA |
| UPMC for Life PPO High Deductible Rx (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $33.00 | PA |
| UPMC for Life HMO Rx (HMO) | UPMC HEALTH PLAN, INC. | T5 | Yes | $33.70 | OH, PA |
| UPMC for Life PPO Rx Enhanced (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $42.70 | PA |
| Mass General Brigham Advantage Secure (HMO-POS) | Mass General Brigham Health Plan, Inc. | T5 | Yes | $62.00 | MA |
| Mass General Brigham Advantage Premier (PPO) | Mass General Brigham Health Plan, Inc. | T5 | Yes | $79.70 | MA |
| UPMC for Life HMO Rx Enhanced (HMO) | UPMC HEALTH PLAN, INC. | T5 | Yes | $93.40 | OH, PA |
| UPMC for Life PPO Rx Enhanced (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $140.00 | PA |
| Mass General Brigham Advantage Signature (PPO) | Mass General Brigham Health Plan, Inc. | T5 | Yes | $147.20 | MA |
Frequently Asked Questions
Is octreotide 20 MG Delayed Release Oral Capsule [Mycapssa] covered by Medicare Part D?
Yes, octreotide 20 MG Delayed Release Oral Capsule [Mycapssa] is covered by 15 Medicare Part D plans (0.3% of all Part D formularies).
What tier is octreotide 20 MG Delayed Release Oral Capsule [Mycapssa] on Medicare Part D plans?
octreotide 20 MG Delayed Release Oral Capsule [Mycapssa] averages Tier 3.7 across Part D plans, ranging from Tier 1 to Tier 5.
Does octreotide 20 MG Delayed Release Oral Capsule [Mycapssa] require prior authorization?
100% of Part D formularies require prior authorization for octreotide 20 MG Delayed Release Oral Capsule [Mycapssa]. Step therapy: 0%. Quantity limits: 33.3%.
How much does Medicare spend on octreotide 20 MG Delayed Release Oral Capsule [Mycapssa]?
In 2023, total Medicare Part D spending on octreotide 20 MG Delayed Release Oral Capsule [Mycapssa] was $6,271,034, covering 3,041 beneficiaries. The average spend per beneficiary was $2,062.16.
Read our methodology - how this data is sourced, computed, and verified.