probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah]
probenecid
RxCUI: 2717850
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 10 distinct formulary files spanning 183 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 3.9.
Real-world access to probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah] depends on utilization management as much as tier placement: 50% of covering formularies require prior authorization. 0% require step therapy. 70% 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
- 10
- Plans covering
- 183
- Coverage rate
- 3.6%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 50% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 70% 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 |
| 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 |
| 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 |
| Freedom Blue PPO Deluxe (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $122.40 | PA |
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 183 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 3.9 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?
50% of Part D formularies require prior authorization for probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah]. Step therapy: 0%. Quantity limits: 70%.
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.