Medicare Part D coverage · penicillamine · RxCUI 198070
penicillamine 250 MG Oral Capsule
Per the CMS 2026 Part D formulary file, penicillamine 250 MG Oral Capsule is covered by 429 Medicare Part D plans (8.5% of enrollable products), averaging Tier 4.3, with prior authorization required on 17.9% of covering formularies.
- 8.5%
- Plan coverage
- 429
- Plans covering
- T4.3
- Avg tier
- 17.9%
- Prior auth required
What the CMS Formulary Data Shows for penicillamine 250 MG Oral Capsule
Per the CMS 2026 Part D formulary file, penicillamine 250 MG Oral Capsule (RxNorm concept RXCUI 198070, generic name penicillamine) appears on 28 distinct formulary files spanning 429 Medicare Part D plan offerings - 8.5% 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 4.3.
Real-world access to penicillamine 250 MG Oral Capsule depends on utilization management as much as tier placement: 17.9% of covering formularies require prior authorization. 10.7% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 162 Part D beneficiaries filled penicillamine 250 MG Oral Capsule in 2023, with total plan-and-beneficiary spending of $9,724,438 and an average per-beneficiary annual cost of $60,027.39. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry penicillamine 250 MG Oral Capsule today.
Coverage Details
- Formularies covering
- 28
- Plans covering
- 429
- Coverage rate
- 8.5%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 17.9% of formularies
- Step therapy required
- 10.7% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 162
- Total spending
- $9,724,438
- Avg per beneficiary
- $60,027.39
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering penicillamine 250 MG Oral Capsule
9 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T5 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T5 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T5 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T5 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T5 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T5 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T5 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T5 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T5 | No | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering penicillamine 250 MG Oral Capsule
91 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| HAP Medicare Explore (PPO) | Alliance Health AND Life Insurance Company | T2 | No | $0 | MI |
| HAP Medicare Prime (PPO) | Alliance Health AND Life Insurance Company | T2 | No | $0 | MI |
| HAP Medicare Connect (HMO) | Health Alliance Plan OF Michigan | T2 | No | $0 | MI |
| HAP Medicare Complete Duals (HMO D-SNP) | Health Alliance Plan OF Michigan | T2 | No | $0 | MI |
| HAP Medicare Superior (HMO) | Health Alliance Plan OF Michigan | T2 | No | $0 | MI |
| Henry Ford Select (HMO) | Health Alliance Plan OF Michigan | T2 | No | $0 | MI |
| HAP Member Assist (PPO) | Alliance Health AND Life Insurance Company | T2 | No | $8.80 | MI |
| HAP Medicare Complete Assist (PPO D-SNP) | Alliance Health AND Life Insurance Company | T2 | No | $8.80 | MI |
| HAP Medicare Diabetes and Heart (HMO C-SNP) | Health Alliance Plan OF Michigan | T2 | No | $8.80 | MI |
| HAP Senior Plus Henry Ford Tiered Access (HMO) | Health Alliance Plan OF Michigan | T2 | No | $11.30 | MI |
| HAP Senior Plus (HMO-POS) | Health Alliance Plan OF Michigan | T2 | No | $13.50 | MI |
| HAP Senior Plus (PPO) | Alliance Health AND Life Insurance Company | T2 | No | $42.60 | MI |
| Network Health Select (PPO) | Network Health Insurance Corporation | T3 | No | $0 | WI |
| Network Health Go (PPO) | Network Health Insurance Corporation | T3 | No | $0 | WI |
| Network Health Anywhere (PPO) | Network Health Insurance Corporation | T3 | No | $0 | WI |
| Network Health Choice (PPO) | Network Health Insurance Corporation | T3 | No | $0 | WI |
| Network Health Zero (PPO) | Network Health Insurance Corporation | T3 | No | $0 | WI |
Show the next 30 plans
| Presbyterian Senior Care Plan 2 with Rx (HMO) | Presbyterian Health Plan | T3 | No | $0 | NM |
| Presbyterian Dual Plus (HMO D-SNP) | Presbyterian Health Plan | T3 | No | $0 | NM |
| Presbyterian Senior Care Extra Health Plan with Rx (HMO) | Presbyterian Health Plan | T3 | No | $0 | NM |
| Network Health Cares (PPO D-SNP) | Network Health Insurance Corporation | T3 | No | $21.10 | WI |
| Network Health PlusRx (PPO) | Network Health Insurance Corporation | T3 | No | $38.60 | WI |
| Presbyterian Senior Care Plan 3 with Rx (HMO) | Presbyterian Health Plan | T3 | No | $65.80 | NM |
| Network Health PremierRx (PPO) | Network Health Insurance Corporation | T3 | No | $92.80 | WI |
| Medicare BlueEssential (PPO) | Excellus Health Plan, Inc. | T5 | No | $0 | NY |
| Medicare BlueActive (PPO) | Excellus Health Plan, Inc. | T5 | No | $0 | NY |
| Medicare BlueVital (PPO) | Excellus Health Plan, Inc. | T5 | No | $0 | NY |
| Univera SeniorChoice Basic (HMO) | Excellus Health Plan, Inc. | T5 | No | $0 | NY |
| Univera SeniorChoice Extra (HMO) | Excellus Health Plan, Inc. | T5 | No | $0 | NY |
| Medicare Blue Choice Core (HMO) | Excellus Health Plan, Inc. | T5 | No | $0 | NY |
| Univera Medicare Dual (HMO D-SNP) | Excellus Health Plan Community Care LLC | T5 | No | $0 | NY |
| Medicare Blue Dual (HMO D-SNP) | Excellus Health Plan Community Care LLC | T5 | No | $0 | NY |
| Providence Medicare Extra Part B Only + Rx (HMO) | Providence Health Assurance | T5 | No | $0 | OR |
| Providence Medicare Prime + Rx (HMO) | Providence Health Assurance | T5 | No | $0 | OR |
| Providence Medicare Dual Plus (HMO D-SNP) | Providence Health Assurance | T5 | No | $0 | OR |
| Providence Medicare Timber + Rx (HMO) | Providence Health Assurance | T5 | No | $0 | OR, WA |
| Providence Medicare Pine + Rx (HMO) | Providence Health Assurance | T5 | No | $0 | WA |
| Providence Medicare Extra + Rx (HMO) | Providence Health Assurance | T5 | No | $0 | OR, WA |
| Providence Medicare Sycamore + Rx (HMO) | Providence Health Assurance | T5 | No | $0 | CA |
| HealthSpring Preferred (HMO) | Bravo Health Pennsylvania, Inc. | T5 | No | $0 | AZ |
| HealthSpring Alliance (HMO) | Bravo Health Pennsylvania, Inc. | T5 | No | $0 | AZ |
| HealthSpring Preferred Savings (HMO) | Bravo Health Pennsylvania, Inc. | T5 | No | $0 | AZ |
| HealthSpring Preferred Full Savings (HMO) | Bravo Health Pennsylvania, Inc. | T5 | No | $0 | AZ |
| HealthSpring Preferred GA (HMO) | Healthspring Life & Health Insurance Company, Inc. | T5 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T5 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T5 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T5 | No | $0 | GA |
Showing top 50 of 91 plans.
Frequently Asked Questions
Is penicillamine 250 MG Oral Capsule covered by Medicare Part D?
Yes, penicillamine 250 MG Oral Capsule is covered by 429 Medicare Part D plans (8.5% of all Part D formularies).
What tier is penicillamine 250 MG Oral Capsule on Medicare Part D plans?
penicillamine 250 MG Oral Capsule averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 5.
Does penicillamine 250 MG Oral Capsule require prior authorization?
17.9% of Part D formularies require prior authorization for penicillamine 250 MG Oral Capsule. Step therapy: 10.7%. Quantity limits: 0%.
How much does Medicare spend on penicillamine 250 MG Oral Capsule?
In 2023, total Medicare Part D spending on penicillamine 250 MG Oral Capsule was $9,724,438, covering 162 beneficiaries. The average spend per beneficiary was $60,027.39.
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
- vigabatrin 500 MG Oral Tablet [Vigadrone] T4.3
- bosentan 32 MG Tablet for Oral Suspension T4.3
- 0.2 ML dalteparin sodium 25000 UNT/ML Prefilled Syringe [Fragmin] T4.3
- {28 (elagolix 300 MG / estradiol 1 MG / norethindrone 0.5 MG Oral Capsule) / 28 (elagolix 300 MG Oral Capsule) } Pack [Oriahnn 28 Day Kit] T4.3
- 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron] T4.3
- 3 ML icatibant 10 MG/ML Prefilled Syringe [Sajazir] T4.3
Similar prior-authorization rate
- {28 (estrogens, conjugated (USP) 0.625 MG / medroxyprogesterone acetate 5 MG Oral Tablet) } Pack [Prempro 0.625/5 28 Day] 17.8% PA
- adapalene 1 MG/ML Topical Cream 17.8% PA
- {28 (estrogens, conjugated (USP) 0.3 MG / medroxyprogesterone acetate 1.5 MG Oral Tablet) } Pack [Prempro 0.3/1.5 28 Day] 17.8% PA
- perfluorohexyloctane 1340 MG/ML Ophthalmic Solution [Miebo] 17.7% PA
- itraconazole 100 MG Oral Capsule 17.7% PA
- 24 HR paliperidone 3 MG Extended Release Oral Tablet 17.7% PA