Medicare Part D coverage · probenecid · RxCUI 2717850
probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah]
Per the CMS 2026 Part D formulary file, probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah] is covered by 184 Medicare Part D plans (3.6% of enrollable products), averaging Tier 3.7, with prior authorization required on 54.5% of covering formularies.
- 3.6%
- Plan coverage
- 184
- Plans covering
- T3.7
- Avg tier
- 54.5%
- Prior auth required
What the CMS Formulary Data Shows for probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah]
Per the CMS 2026 Part D formulary file, probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah] (RxNorm concept RXCUI 2717850, generic name probenecid) appears on 11 distinct formulary files spanning 184 Medicare Part D plan offerings - 3.6% 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 3.7.
Real-world access to probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah] depends on utilization management as much as tier placement: 54.5% of covering formularies require prior authorization. 0% require step therapy. 72.7% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 15,132 Part D beneficiaries filled probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah] in 2023, with total plan-and-beneficiary spending of $6,279,976 and an average per-beneficiary annual cost of $415.01. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah] today.
Coverage Details
- Formularies covering
- 11
- Plans covering
- 184
- Coverage rate
- 3.6%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 54.5% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 72.7% of formularies
2023 Medicare Spending
- Beneficiaries
- 15,132
- Total spending
- $6,279,976
- Avg per beneficiary
- $415.01
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah]
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP) | HM Health Insurance Company | T4 | No | No | $164.80 | - |
| Blue Rx PDP Plus (PDP) | HM Health Insurance Company | T4 | No | No | $193.20 | - |
Medicare Advantage Plans (MA-PD) Covering probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah]
98 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T2 | Yes | $0 | CA |
| Community Blue Medicare HMO Signature (HMO) | Highmark Western and Northeastern New York Inc. | T4 | No | $0 | NY |
| Community Blue Medicare HMO Merit (HMO) | Highmark Western and Northeastern New York Inc. | T4 | No | $0 | NY |
| Community Blue Medicare PPO Signature (PPO) | Highmark Senior Health Company | T4 | No | $0 | PA |
| Complete Blue PPO Signature (PPO) | Highmark Senior Health Company | T4 | No | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | Highmark Senior Health Company | T4 | No | $0 | PA |
| Complete Blue PPO Signature (PPO) | Highmark Senior Health Company | T4 | No | $0 | PA |
| Complete Blue PPO Merit (PPO) | Highmark Senior Health Company | T4 | No | $0 | PA |
| Complete Blue PPO Signature (PPO) | Highmark Senior Health Company | T4 | No | $0 | PA |
| Complete Blue PPO Distinct (PPO) | Highmark Senior Health Company | T4 | No | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | Highmark Senior Health Company | T4 | No | $0 | PA |
| Complete Blue Plus PPO Merit (PPO) | Highmark Senior Health Company | T4 | No | $0 | PA |
| Community Blue Medicare PPO Signature (PPO) | Highmark Senior Health Company | T4 | No | $0 | PA |
| Complete Blue PPO Merit (PPO) | Highmark Senior Health Company | T4 | No | $0 | PA |
| Community Blue Medicare HMO Signature (HMO) | Highmark Choice Company | T4 | No | $0 | PA |
| Security Blue HMO-POS ValueRx (HMO-POS) | Highmark Choice Company | T4 | No | $0 | PA |
| Community Blue Medicare HMO Signature (HMO) | Highmark Choice Company | T4 | No | $0 | PA |
| Together Blue Medicare HMO Signature (HMO) | Highmark Choice Company | T4 | No | $0 | PA |
Show the next 30 plans
| Community Blue Medicare HMO Distinct (HMO) | Highmark Choice Company | T4 | No | $0 | PA |
| Complete Blue HMO Distinct (HMO) | Highmark Choice Company | T4 | No | $0 | PA |
| Complete Blue PPO Distinct (PPO) | Highmark Senior Solutions Company | T4 | No | $0 | WV |
| Complete Blue PPO Signature (PPO) | Highmark Senior Solutions Company | T4 | No | $0 | WV |
| Complete Blue PPO Signature (PPO) | Highmark Senior Solutions Company | T4 | No | $0 | WV |
| Complete Blue PPO Merit (PPO) | Highmark Senior Solutions Company | T4 | No | $0 | WV |
| Complete Blue PPO Signature (PPO) | Highmark Bcbsd Inc. | T4 | No | $0 | DE |
| Senior Blue 652 (HMO) | Highmark Western and Northeastern New York Inc. | T4 | No | $0.40 | NY |
| Complete Blue PPO Distinct (PPO) | Highmark Senior Health Company | T4 | No | $1.00 | PA |
| Complete Blue PPO Distinct (PPO) | Highmark Senior Health Company | T4 | No | $6.00 | PA |
| Community Blue Medicare HMO Distinct (HMO) | Highmark Western and Northeastern New York Inc. | T4 | No | $6.80 | NY |
| Security Blue HMO-POS ValueRx (HMO-POS) | Highmark Choice Company | T4 | No | $10.00 | PA |
| Complete Blue PPO Distinct (PPO) | Highmark Senior Health Company | T4 | No | $11.00 | PA |
| Complete Blue Plus PPO Distinct (PPO) | Highmark Senior Health Company | T4 | No | $11.00 | PA |
| Complete Blue PPO Distinct (PPO) | Highmark Senior Solutions Company | T4 | No | $29.00 | WV |
| Senior Blue 651 (HMO) | Highmark Western and Northeastern New York Inc. | T4 | No | $30.00 | NY |
| Complete Blue PPO Distinct (PPO) | Highmark Bcbsd Inc. | T4 | No | $36.90 | DE |
| Freedom Blue PPO ValueRx (PPO) | Highmark Senior Health Company | T4 | No | $37.20 | PA |
| Freedom Blue PPO ValueRx (PPO) | Highmark Senior Health Company | T4 | No | $44.00 | PA |
| Complete Blue PPO Distinct (PPO) | Highmark Bcbsd Inc. | T4 | No | $48.00 | DE |
| Security Blue HMO-POS Standard (HMO-POS) | Highmark Choice Company | T4 | No | $51.80 | PA |
| Freedom Blue PPO Standard (PPO) | Highmark Senior Solutions Company | T4 | No | $65.20 | WV |
| Freedom Blue PPO ValueRx (PPO) | Highmark Senior Health Company | T4 | No | $77.00 | PA |
| Forever Blue Value (PPO) | Highmark Western and Northeastern New York Inc. | T4 | No | $77.40 | NY |
| Freedom Blue PPO Select (PPO) | Highmark Senior Health Company | T4 | No | $95.70 | PA |
| Security Blue HMO-POS Deluxe (HMO-POS) | Highmark Choice Company | T4 | No | $95.90 | PA |
| Freedom Blue PPO Standard (PPO) | Highmark Senior Health Company | T4 | No | $98.20 | PA |
| Forever Blue 770 (PPO) | Highmark Western and Northeastern New York Inc. | T4 | No | $104.40 | NY |
| Forever Blue 751 (PPO) | Highmark Western and Northeastern New York Inc. | T4 | No | $108.80 | NY |
| Freedom Blue PPO Select (PPO) | Highmark Senior Health Company | T4 | No | $115.70 | PA |
Showing top 50 of 98 plans.
Frequently Asked Questions
Is probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah] covered by Medicare Part D?
Yes, probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah] is covered by 184 Medicare Part D plans (3.6% of all Part D formularies).
What tier is probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah] on Medicare Part D plans?
probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah] averages Tier 3.7 across Part D plans, ranging from Tier 1 to Tier 5.
Does probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah] require prior authorization?
54.5% of Part D formularies require prior authorization for probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah]. Step therapy: 0%. Quantity limits: 72.7%.
How much does Medicare spend on probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah]?
In 2023, total Medicare Part D spending on probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah] was $6,279,976, covering 15,132 beneficiaries. The average spend per beneficiary was $415.01.
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
- Soft Gelatin methoxsalen 10 MG Oral Capsule T3.7
- nifurtimox 30 MG Oral Tablet [Lampit] T3.7
- lactulose 20000 MG Powder for Oral Solution [Kristalose] T3.7
- certolizumab pegol 200 MG Injection [Cimzia] T3.7
- {1 (0.1 ML) (diazepam 100 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 10 MG Dose Kit] T3.7
- {2 (0.1 ML) (diazepam 75 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 15 MG Dose Kit] T3.7
Similar prior-authorization rate
- cyclobenzaprine hydrochloride 5 MG Oral Tablet 54.6% PA
- perampanel 0.5 MG/ML Oral Suspension [FYCOMPA] 54.6% PA
- rufinamide 200 MG Oral Tablet 54.9% PA
- rufinamide 400 MG Oral Tablet 54.9% PA
- hydroxyzine hydrochloride 10 MG Oral Tablet 55.1% PA
- 24 HR selegiline 0.25 MG/HR Transdermal System [Emsam] 55.2% PA