Medicare Part D coverage · octreotide · RxCUI 2380617
octreotide 20 MG Delayed Release Oral Capsule [Mycapssa]
Per the CMS 2026 Part D formulary file, octreotide 20 MG Delayed Release Oral Capsule [Mycapssa] is covered by 15 Medicare Part D plans (0.3% of enrollable products), averaging Tier 3.7, with prior authorization required on 100% of covering formularies.
- 0.3%
- Plan coverage
- 15
- Plans covering
- T3.7
- Avg tier
- 100%
- Prior auth required
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 $6,239,026 and an average per-beneficiary annual cost of $2,051.64. 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
- $6,239,026
- Avg per beneficiary
- $2,051.64
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 $6,239,026, covering 3,041 beneficiaries. The average spend per beneficiary was $2,051.64.
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
- Modified 24 HR metformin hydrochloride 500 MG Extended Release Oral Tablet T3.7
- ergotamine tartrate 2 MG Sublingual Tablet [Ergomar] T3.7
- sildenafil 10 MG/ML Oral Suspension T3.7
- somatropin 12 MG Cartridge [Humatrope] T3.7
- baclofen 5 MG/ML Oral Suspension T3.7
- nitrofurantoin 10 MG/ML Oral Suspension T3.7
Similar prior-authorization rate
- azathioprine 50 MG Oral Tablet 100% PA
- 0.5 ML hepatitis B surface antigen vaccine 0.04 MG/ML Prefilled Syringe [Heplisav-B] 100% PA
- 0.5 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] 100% PA
- 1 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] 100% PA
- sodium phenylbutyrate 0.483 MG/MG Oral Pellet [Pheburane] 100% PA
- sotagliflozin 200 MG Oral Tablet [Inpefa] 100% PA