progesterone 0.04 MG/MG Vaginal Gel [Crinone]
progesterone
RxCUI: 153579
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 42 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
- 42
- 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]
42 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 |
| 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 Dual Care Alliance (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 42 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.