Medicare Part D coverage · Pediatric · RxCUI 2639743
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] is covered by 3,230 Medicare Part D plans (63.9% of enrollable products), averaging Tier 4.5, with prior authorization required on 92.5% of covering formularies.
- 63.9%
- Plan coverage
- 3,230
- 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 173 distinct formulary files spanning 3,230 Medicare Part D plan offerings - 63.9% 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. 46.8% 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
- 173
- Plans covering
- 3,230
- Coverage rate
- 63.9%
- 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
- 46.8% of formularies
Tier Distribution Across Plans
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 |
Show the next 30 plans
| 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 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 |
| Highmark Health Options Duals Select (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $31.20 | DE |
| 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 |
| Hamaspik Medicare Select (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $34.50 | NY |
Showing top 50 of 95 plans.
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 3,230 Medicare Part D plans (63.9% 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: 46.8%.
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
- mavorixafor 100 MG Oral Capsule [Xolremdi] T4.5
- lenalidomide 10 MG Oral Capsule [Revlimid] T4.5
- 0.6 ML pegfilgrastim-cbqv 10 MG/ML Auto-Injector [Udenyca] T4.5
- 1.7 ML denosumab-nxxp 70 MG/ML Injection [Bilprevda] T4.5
- 1 ML tbo-filgrastim 0.3 MG/ML Injection [Granix] T4.5
- 0.5 ML filgrastim 0.6 MG/ML Prefilled Syringe [Neupogen] T4.5
Similar prior-authorization rate
- Once-Daily gabapentin 900 MG Oral Tablet 92.6% PA
- Hyponatremia tolvaptan 30 MG Oral Tablet 92.7% PA
- glutamine 5000 MG Powder for Oral Solution [Endari] 92.3% PA
- {28 (alpelisib 125 MG Oral Tablet [Vijoice]) } Pack [Vijoice 125 MG 28 Day] 92.3% PA
- givinostat 8.86 MG/ML Oral Suspension [Duvyzat] 92.3% PA
- tretinoin 0.5 MG/ML Topical Cream 92.1% PA