penicillamine 250 MG Oral Capsule
penicillamine
RxCUI: 198070
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 $10,124,031 and an average per-beneficiary annual cost of $62,494.02. 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
- $10,124,031
- Avg per beneficiary
- $62,494.02
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 |
| 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 |
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 $10,124,031, covering 162 beneficiaries. The average spend per beneficiary was $62,494.02.
Read our methodology - how this data is sourced, computed, and verified.