prasterone 6.5 MG Vaginal Insert [Intrarosa]
prasterone
RxCUI: 1927693
What the CMS Formulary Data Shows for prasterone 6.5 MG Vaginal Insert [Intrarosa]
Per the CMS 2026 Part D formulary file, prasterone 6.5 MG Vaginal Insert [Intrarosa] (RxNorm concept RXCUI 1927693, generic name prasterone) appears on 7 distinct formulary files spanning 39 Medicare Part D plan offerings - 0.8% 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 3.3.
Real-world access to prasterone 6.5 MG Vaginal Insert [Intrarosa] depends on utilization management as much as tier placement: 42.9% of covering formularies require prior authorization. 0% require step therapy. 28.6% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 3,100 Part D beneficiaries filled prasterone 6.5 MG Vaginal Insert [Intrarosa] in 2023, with total plan-and-beneficiary spending of $3,782,382 and an average per-beneficiary annual cost of $1,220.12. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry prasterone 6.5 MG Vaginal Insert [Intrarosa] today.
Coverage Details
- Formularies covering
- 7
- Plans covering
- 39
- Coverage rate
- 0.8%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 42.9% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 28.6% of formularies
2023 Medicare Spending
- Beneficiaries
- 3,100
- Total spending
- $3,782,382
- Avg per beneficiary
- $1,220.12
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering prasterone 6.5 MG Vaginal Insert [Intrarosa]
39 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK HEALTH OPTIONS WEST VIRGINIA INC. | T1 | No | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | No | $0 | DE |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $13.10 | PA |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $17.60 | PA |
| Highmark Health Options Duals Select (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | No | $31.20 | DE |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Flex (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Active (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Select Health Medicare Wellness (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Network Health Select (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $0 | WI |
| Network Health Go (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $0 | WI |
| Network Health Anywhere (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $0 | WI |
| Network Health Choice (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $0 | WI |
| Network Health Zero (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $0 | WI |
| Healthy Mississippi Premier Advantage (HMO-POS) | Healthy Mississippi, Inc. | T4 | No | $0 | MS |
| FHCP Medicare Classic (HMO) | FLORIDA BLUE MEDICARE, INC. | T4 | No | $0 | FL |
| Network Health Cares (PPO D-SNP) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $21.10 | WI |
| Network Health PlusRx (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $38.60 | WI |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | Yes | $47.00 | PA |
| FHCP Medicare Rx Plus (HMO-POS) | FLORIDA BLUE MEDICARE, INC. | T4 | No | $49.00 | FL |
| Keystone 65 Preferred Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | Yes | $59.70 | PA |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | Yes | $63.50 | PA |
| Keystone 65 Preferred Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | Yes | $79.70 | PA |
| Network Health PremierRx (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $92.80 | WI |
| Personal Choice 65 Rx (PPO) | QCC INSURANCE COMPANY | T4 | Yes | $102.20 | PA |
| Personal Choice 65 Rx (PPO) | QCC INSURANCE COMPANY | T4 | Yes | $112.70 | PA |
Frequently Asked Questions
Is prasterone 6.5 MG Vaginal Insert [Intrarosa] covered by Medicare Part D?
Yes, prasterone 6.5 MG Vaginal Insert [Intrarosa] is covered by 39 Medicare Part D plans (0.8% of all Part D formularies).
What tier is prasterone 6.5 MG Vaginal Insert [Intrarosa] on Medicare Part D plans?
prasterone 6.5 MG Vaginal Insert [Intrarosa] averages Tier 3.3 across Part D plans, ranging from Tier 1 to Tier 4.
Does prasterone 6.5 MG Vaginal Insert [Intrarosa] require prior authorization?
42.9% of Part D formularies require prior authorization for prasterone 6.5 MG Vaginal Insert [Intrarosa]. Step therapy: 0%. Quantity limits: 28.6%.
How much does Medicare spend on prasterone 6.5 MG Vaginal Insert [Intrarosa]?
In 2023, total Medicare Part D spending on prasterone 6.5 MG Vaginal Insert [Intrarosa] was $3,782,382, covering 3,100 beneficiaries. The average spend per beneficiary was $1,220.12.
Read our methodology - how this data is sourced, computed, and verified.