Medicare Part D coverage · progesterone · RxCUI 153579
progesterone 0.04 MG/MG Vaginal Gel [Crinone]
Per the CMS 2026 Part D formulary file, progesterone 0.04 MG/MG Vaginal Gel [Crinone] is covered by 41 Medicare Part D plans (0.8% of enrollable products), averaging Tier 3.1, with prior authorization required on 88.9% of covering formularies.
- 0.8%
- Plan coverage
- 41
- Plans covering
- T3.1
- Avg tier
- 88.9%
- Prior auth required
What the CMS Formulary Data Shows for progesterone 0.04 MG/MG Vaginal Gel [Crinone]
Per the CMS 2026 Part D formulary file, progesterone 0.04 MG/MG Vaginal Gel [Crinone] (RxNorm concept RXCUI 153579, generic name progesterone) appears on 9 distinct formulary files spanning 41 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 3.1.
Real-world access to progesterone 0.04 MG/MG Vaginal Gel [Crinone] depends on utilization management as much as tier placement: 88.9% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 109 Part D beneficiaries filled progesterone 0.04 MG/MG Vaginal Gel [Crinone] in 2023, with total plan-and-beneficiary spending of $13,830 and an average per-beneficiary annual cost of $126.88. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry progesterone 0.04 MG/MG Vaginal Gel [Crinone] today.
Coverage Details
- Formularies covering
- 9
- Plans covering
- 41
- Coverage rate
- 0.8%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 88.9% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 109
- Total spending
- $13,830
- Avg per beneficiary
- $126.88
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering progesterone 0.04 MG/MG Vaginal Gel [Crinone]
41 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 |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | Selecthealth, Inc. | T4 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | UT |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | NV |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | CO |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | CO |
| Select Health Medicare Flex (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | CO |
| Select Health Medicare Active (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | Selecthealth, Inc. | T4 | Yes | $0 | NV |
| Select Health Medicare Wellness (HMO) | Selecthealth, Inc. | T4 | Yes | $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 |
Show the next 21 plans
| 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 | Yes | $0 | MS |
| Mass General Brigham Advantage (PPO) | Mass General Brigham Health Plan, Inc. | T4 | Yes | $0 | MA |
| PacificSource Medicare Essentials Rx 27 (HMO) | Pacificsource Community Health Plans | T4 | No | $0 | OR |
| PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) | Pacificsource Community Health Plans | T4 | No | $0 | MT |
| PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) | Pacificsource Community Health Plans | T4 | No | $0 | OR |
| PacificSource Medicare MyCare Rx 40 (HMO) | Pacificsource Community Health Plans | T4 | No | $0 | OR |
| PacificSource Dual Care (HMO D-SNP) | Pacificsource Community Health Plans | T4 | No | $0 | OR |
| PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) | Pacificsource Community Health Plans | T4 | No | $19.00 | ID |
| Network Health Cares (PPO D-SNP) | Network Health Insurance Corporation | T4 | Yes | $21.10 | WI |
| PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) | Pacificsource Community Health Plans | T4 | No | $29.10 | OR |
| Network Health PlusRx (PPO) | Network Health Insurance Corporation | T4 | Yes | $38.60 | WI |
| PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) | Pacificsource Community Health Plans | T4 | No | $52.00 | ID |
| Mass General Brigham Advantage Secure (HMO-POS) | Mass General Brigham Health Plan, Inc. | T4 | Yes | $62.00 | MA |
| PacificSource Medicare Essentials Rx 41 (HMO) | Pacificsource Community Health Plans | T4 | No | $69.30 | OR |
| Mass General Brigham Advantage Premier (PPO) | Mass General Brigham Health Plan, Inc. | T4 | Yes | $79.70 | MA |
| PacificSource Medicare Explorer Rx 4 (PPO) | Pacificsource Community Health Plans | T4 | No | $88.70 | OR |
| Network Health PremierRx (PPO) | Network Health Insurance Corporation | T4 | Yes | $92.80 | WI |
| PacificSource Medicare Essentials Rx 6 (HMO) | Pacificsource Community Health Plans | T4 | No | $105.90 | OR |
| Mass General Brigham Advantage Signature (PPO) | Mass General Brigham Health Plan, Inc. | T4 | Yes | $147.20 | MA |
Frequently Asked Questions
Is progesterone 0.04 MG/MG Vaginal Gel [Crinone] covered by Medicare Part D?
Yes, progesterone 0.04 MG/MG Vaginal Gel [Crinone] is covered by 41 Medicare Part D plans (0.8% of all Part D formularies).
What tier is progesterone 0.04 MG/MG Vaginal Gel [Crinone] on Medicare Part D plans?
progesterone 0.04 MG/MG Vaginal Gel [Crinone] averages Tier 3.1 across Part D plans, ranging from Tier 1 to Tier 4.
Does progesterone 0.04 MG/MG Vaginal Gel [Crinone] require prior authorization?
88.9% of Part D formularies require prior authorization for progesterone 0.04 MG/MG Vaginal Gel [Crinone]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on progesterone 0.04 MG/MG Vaginal Gel [Crinone]?
In 2023, total Medicare Part D spending on progesterone 0.04 MG/MG Vaginal Gel [Crinone] was $13,830, covering 109 beneficiaries. The average spend per beneficiary was $126.88.
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
- aripiprazole 15 MG Disintegrating Oral Tablet T3.1
- isotretinoin 30 MG Oral Capsule [Amnesteem] T3.1
- Pulmonary Hypertension tadalafil 20 MG Oral Tablet [Alyq] T3.1
- 1250 MG testosterone 0.0162 MG/MG Topical Gel T3.1
- dextroamphetamine sulfate 5 MG Extended Release Oral Capsule T3.1
- 24 HR pramipexole dihydrochloride 1.5 MG Extended Release Oral Tablet T3.1
Similar prior-authorization rate
- carglumic acid 200 MG Tablet for Oral Suspension 89.1% PA
- 1.56 ML abaloparatide 2 MG/ML Pen Injector [Tymlos] 88.5% PA
- 0.6 ML pegfilgrastim 10 MG/ML Prefilled Syringe [Neulasta] 88.4% PA
- tretinoin 0.0005 MG/MG Topical Gel 89.4% PA
- {112 (treprostinil 0.016 MG Inhalation Powder [Tyvaso]) / 112 (treprostinil 0.032 MG Inhalation Powder [Tyvaso]) / 28 (treprostinil 0.048 MG Inhalation Powder [Tyvaso]) } Pack [Tyvaso 16-32-48 MCG Titration Pack] 89.5% PA
- treprostinil 0.016 MG Inhalation Powder [Tyvaso] 89.5% PA