ospemifene 60 MG Oral Tablet [Osphena]
ospemifene
RxCUI: 1370982
What the CMS Formulary Data Shows for ospemifene 60 MG Oral Tablet [Osphena]
Per the CMS 2026 Part D formulary file, ospemifene 60 MG Oral Tablet [Osphena] (RxNorm concept RXCUI 1370982, generic name ospemifene) appears on 49 distinct formulary files spanning 1,127 Medicare Part D plan offerings - 22.2% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 3.1.
Real-world access to ospemifene 60 MG Oral Tablet [Osphena] depends on utilization management as much as tier placement: 77.6% of covering formularies require prior authorization. 0% require step therapy. 69.4% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 4,511 Part D beneficiaries filled ospemifene 60 MG Oral Tablet [Osphena] in 2023, with total plan-and-beneficiary spending of $8,451,359 and an average per-beneficiary annual cost of $1,873.50. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry ospemifene 60 MG Oral Tablet [Osphena] today.
Coverage Details
- Formularies covering
- 49
- Plans covering
- 1,127
- Coverage rate
- 22.2%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 77.6% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 69.4% of formularies
2023 Medicare Spending
- Beneficiaries
- 4,511
- Total spending
- $8,451,359
- Avg per beneficiary
- $1,873.50
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering ospemifene 60 MG Oral Tablet [Osphena]
5 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T3 | Yes | No | $0 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T3 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T3 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T3 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T3 | Yes | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering ospemifene 60 MG Oral Tablet [Osphena]
95 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| NaviCare (HMO D-SNP) | FALLON COMMUNITY HEALTH PLAN | T1 | Yes | $0 | MA |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | Yes | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | Yes | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | Yes | $0 | IN |
| Provider Partners Maryland Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | Yes | $0 | MD |
| Provider Partners Missouri Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | Yes | $0 | MO |
| 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 |
| 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 |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC. | T1 | Yes | $4.80 | TX |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS | T1 | Yes | $15.20 | IL |
| Provider Partners Maryland Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | Yes | $31.20 | MD |
| Provider Partners Maryland Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | Yes | $31.20 | MD |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | Yes | $32.70 | PA |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | Yes | $32.70 | PA |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | Yes | $36.20 | NC |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | Yes | $36.20 | NC |
| Provider Partners Indiana Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | Yes | $38.40 | IN |
| Provider Partners Indiana Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | Yes | $38.40 | IN |
| Provider Partners Kentucky Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF KENTUCKY | T1 | Yes | $38.40 | KY |
| Provider Partners Missouri Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | Yes | $43.00 | MO |
| Provider Partners Missouri Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | Yes | $43.00 | MO |
| CareAdvantage (HMO D-SNP) | SAN MATEO HEALTH COMMISSION | T2 | Yes | $0 | CA |
| UHC Dual Complete IA-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T3 | Yes | $0 | IA |
| UHC Dual Complete MO-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T3 | Yes | $0 | MO |
| UHC Dual Complete NE-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T3 | Yes | $0 | NE |
| UHC Dual Complete KS-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T3 | Yes | $0 | KS |
| UHC Dual Complete MO-S3 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T3 | Yes | $0 | MO |
| UHC Dual Complete KS-Q1 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T3 | Yes | $0 | KS |
| UHC Dual Complete TN-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T3 | Yes | $0 | TN |
| UHC Dual Complete TN-Y001 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T3 | Yes | $0 | TN |
| UHC Dual Complete TN-Y2 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T3 | Yes | $0 | TN |
| AARP Medicare Advantage from UHC MI-0001 (PPO) | UNITEDHEALTHCARE INSURANCE COMPANY | T3 | Yes | $0 | MI |
| UHC Dual Complete NM-Y1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T3 | Yes | $0 | NM |
| UHC Dual Complete NM-S1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T3 | Yes | $0 | NM |
| UHC Dual Complete NM-V1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T3 | Yes | $0 | NM |
| UHC Dual Complete AZ-S001 (HMO-POS D-SNP) | ARIZONA PHYSICIANS IPA, INC. | T3 | Yes | $0 | AZ |
| UHC Dual Complete AZ-Y001 (HMO-POS D-SNP) | ARIZONA PHYSICIANS IPA, INC. | T3 | Yes | $0 | AZ |
| UHC Dual Complete VA-Y4 (PPO D-SNP) | CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO. | T3 | Yes | $0 | VA |
| AARP Medicare Advantage from UHC AL-0001 (HMO-POS) | UNITEDHEALTHCARE OF THE MIDLANDS, INC. | T3 | Yes | $0 | AL |
| AARP Medicare Advantage from UHC CA-0002 (HMO-POS) | UHC OF CALIFORNIA | T3 | Yes | $0 | CA |
| UHC Sharp Medicare Advantage CA-001P (HMO-POS) | UHC OF CALIFORNIA | T3 | Yes | $0 | CA |
| AARP Medicare Advantage from UHC CA-003P (HMO-POS) | UHC OF CALIFORNIA | T3 | Yes | $0 | CA |
| AARP Medicare Advantage from UHC CA-0012 (HMO-POS) | UHC OF CALIFORNIA | T3 | Yes | $0 | CA |
| AARP Medicare Advantage from UHC CA-004P (HMO-POS) | UHC OF CALIFORNIA | T3 | Yes | $0 | CA |
| AARP Medicare Advantage from UHC CA-005P (HMO-POS) | UHC OF CALIFORNIA | T3 | Yes | $0 | CA |
| AARP Medicare Advantage from UHC CA-006P (HMO-POS) | UHC OF CALIFORNIA | T3 | Yes | $0 | CA |
Frequently Asked Questions
Is ospemifene 60 MG Oral Tablet [Osphena] covered by Medicare Part D?
Yes, ospemifene 60 MG Oral Tablet [Osphena] is covered by 1,127 Medicare Part D plans (22.2% of all Part D formularies).
What tier is ospemifene 60 MG Oral Tablet [Osphena] on Medicare Part D plans?
ospemifene 60 MG Oral Tablet [Osphena] averages Tier 3.1 across Part D plans, ranging from Tier 1 to Tier 4.
Does ospemifene 60 MG Oral Tablet [Osphena] require prior authorization?
77.6% of Part D formularies require prior authorization for ospemifene 60 MG Oral Tablet [Osphena]. Step therapy: 0%. Quantity limits: 69.4%.
How much does Medicare spend on ospemifene 60 MG Oral Tablet [Osphena]?
In 2023, total Medicare Part D spending on ospemifene 60 MG Oral Tablet [Osphena] was $8,451,359, covering 4,511 beneficiaries. The average spend per beneficiary was $1,873.50.
Read our methodology - how this data is sourced, computed, and verified.