Medicare Part D coverage · risperidone · RxCUI 706827

risperidone 37.5 MG Injection [Risperdal]

Per the CMS 2026 Part D formulary file, risperidone 37.5 MG Injection [Risperdal] is covered by 1,341 Medicare Part D plans (26.5% of enrollable products), averaging Tier 4.5, with prior authorization required on 4.2% of covering formularies.

26.5%
Plan coverage
1,341
Plans covering
T4.5
Avg tier
4.2%
Prior auth required

Verify with CMS →

Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.

What the CMS Formulary Data Shows for risperidone 37.5 MG Injection [Risperdal]

Per the CMS 2026 Part D formulary file, risperidone 37.5 MG Injection [Risperdal] (RxNorm concept RXCUI 706827, generic name risperidone) appears on 24 distinct formulary files spanning 1,341 Medicare Part D plan offerings - 26.5% 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 4.5.

Real-world access to risperidone 37.5 MG Injection [Risperdal] depends on utilization management as much as tier placement: 4.2% of covering formularies require prior authorization. 8.3% require step therapy. 83.3% apply quantity limits.

Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 478,904 Part D beneficiaries filled risperidone 37.5 MG Injection [Risperdal] in 2023, with total plan-and-beneficiary spending of $60,762,873 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 risperidone 37.5 MG Injection [Risperdal] today.

Coverage Details

Formularies covering
24
Plans covering
1,341
Coverage rate
26.5%
Tier range
Tier 1 – Tier 5
Average tier
Tier 5, Specialty

Restrictions

Prior authorization required
4.2% of formularies
Step therapy required
8.3% of formularies
Quantity limits
83.3% of formularies

2023 Medicare Spending

Beneficiaries
478,904
Total spending
$60,762,873
Avg per beneficiary
$126.88

Tier Distribution Across Plans

6 plans
Tier 1, Preferred Generic
94 plans
Tier 4, Non-Preferred

Standalone Drug Plans (PDP) Covering risperidone 37.5 MG Injection [Risperdal]

94 standalone prescription drug plans include this drug.

Plan Insurer Tier PA ST Premium States
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Show the next 30 plans
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $0.40 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $2.50 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $4.30 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $4.40 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $4.70 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $6.60 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $6.80 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $8.40 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $9.90 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $10.10 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $10.60 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $15.50 -
Humana Basic Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $16.50 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $19.30 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $19.40 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $19.40 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $20.80 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $22.10 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $22.90 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $23.70 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $25.90 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $32.00 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $33.70 -
Humana Value Rx Plan (PDP) Humana Insurance Co. & Humana Insurance Co. of NY T4 No No $33.70 -

Showing top 50 of 94 plans.

Medicare Advantage Plans (MA-PD) Covering risperidone 37.5 MG Injection [Risperdal]

6 Medicare Advantage plans with Part D drug coverage include this drug.

Plan Insurer Tier PA Premium States
Hamaspik Medicare Choice (HMO D-SNP) Hamaspik, Inc. T1 No $0 NY
Platino Blindao (HMO D-SNP) Triple S Advantage, Inc. T1 No $0 PR
Platino Enlace (HMO D-SNP) Triple S Advantage, Inc. T1 No $0 PR
Platino Advance (HMO D-snp) Triple S Advantage, Inc. T1 No $0 PR
Platino Plus (HMO D-snp) Triple S Advantage, Inc. T1 No $0 PR
Hamaspik Medicare Select (HMO D-SNP) Hamaspik, Inc. T1 No $34.50 NY

Frequently Asked Questions

Is risperidone 37.5 MG Injection [Risperdal] covered by Medicare Part D?

Yes, risperidone 37.5 MG Injection [Risperdal] is covered by 1,341 Medicare Part D plans (26.5% of all Part D formularies).

What tier is risperidone 37.5 MG Injection [Risperdal] on Medicare Part D plans?

risperidone 37.5 MG Injection [Risperdal] averages Tier 4.5 across Part D plans, ranging from Tier 1 to Tier 5.

Does risperidone 37.5 MG Injection [Risperdal] require prior authorization?

4.2% of Part D formularies require prior authorization for risperidone 37.5 MG Injection [Risperdal]. Step therapy: 8.3%. Quantity limits: 83.3%.

How much does Medicare spend on risperidone 37.5 MG Injection [Risperdal]?

In 2023, total Medicare Part D spending on risperidone 37.5 MG Injection [Risperdal] was $60,762,873, covering 478,904 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

Similar prior-authorization rate

Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare