Pediatric 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron]
Pediatric
RxCUI: 2639743
Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.
64%
Plan Coverage
3,243
Plans Covering
T4.5
Avg Tier
92.5%
Prior Auth Required
What the CMS Formulary Data Shows for Pediatric 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron]
Per the CMS 2026 Part D formulary file, Pediatric 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron] (RxNorm concept RXCUI 2639743, generic name Pediatric) appears on 174 distinct formulary files spanning 3,243 Medicare Part D plan offerings - 64% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.5.
Real-world access to Pediatric 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron] depends on utilization management as much as tier placement: 92.5% of covering formularies require prior authorization. 0% require step therapy. 47.1% apply quantity limits.
Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry Pediatric 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron] today.
Coverage Details
- Formularies covering
- 174
- Plans covering
- 3,243
- Coverage rate
- 64%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 92.5% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 47.1% of formularies
Tier Distribution Across Plans
62 plans
Tier 1, Preferred Generic
2 plans
Tier 2, Generic
10 plans
Tier 4, Non-Preferred
26 plans
Tier 5, Specialty
Standalone Drug Plans (PDP) Covering Pediatric 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron]
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 | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T5 | Yes | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering Pediatric 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron]
95 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | HPMP OF FLORIDA, INC. | T1 | Yes | $0 | FL |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | ELDERPLAN, INC. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | HEALTH CHOICE ARIZONA, INC. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | HEALTHFIRST HEALTH PLAN, INC. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | ITASCA MEDICAL CARE | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | HOPKINS HEALTH ADVANTAGE, INC. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | METROPLUS HEALTH PLAN, INC. | T1 | Yes | $0 | NY |
| Senior Whole Health SCO (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | Yes | $0 | MA |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | Yes | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | HORIZON HEALTHCARE OF NEW JERSEY, INC. | T1 | Yes | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $0 | NY |
| CCA One Care (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | 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 |
| Platino Blindao (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| PLATINO ADVANCE (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| PLATINO PLUS (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | Yes | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | Yes | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK HEALTH OPTIONS WEST VIRGINIA INC. | T1 | Yes | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | Yes | $0 | DE |
| Florida Complete Care (HMO I-SNP) | HPMP OF FLORIDA, INC. | T1 | Yes | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | HPMP OF FLORIDA, INC. | T1 | Yes | $4.80 | FL |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | HCSC INSURANCE SERVICES COMPANY | T1 | Yes | $4.80 | TX |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T1 | Yes | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC. | T1 | Yes | $4.80 | TX |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS INSURANCE COMPANY | T1 | Yes | $5.00 | OK |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | Yes | $13.10 | PA |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS | T1 | Yes | $15.20 | IL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T1 | Yes | $17.00 | AZ |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | Yes | $17.60 | PA |
| Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) | ELDERPLAN, INC. | T1 | Yes | $22.70 | NY |
| VIVA Medicare Extra Value (HMO D-SNP) | VIVA HEALTH, INC. | T1 | Yes | $27.70 | AL |
| VIVA Medicare Extra Care (HMO D-SNP) | VIVA HEALTH, INC. | T1 | Yes | $27.70 | AL |
| 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 |
| Highmark Health Options Duals Select (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | Yes | $31.20 | DE |
Frequently Asked Questions
Is Pediatric 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron] covered by Medicare Part D?
Yes, Pediatric 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron] is covered by 3,243 Medicare Part D plans (64% of all Part D formularies).
What tier is Pediatric 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron] on Medicare Part D plans?
Pediatric 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron] averages Tier 4.5 across Part D plans, ranging from Tier 1 to Tier 5.
Does Pediatric 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron] require prior authorization?
92.5% of Part D formularies require prior authorization for Pediatric 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron]. Step therapy: 0%. Quantity limits: 47.1%.
Read our methodology - how this data is sourced, computed, and verified.
Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare Editorial