risperidone 12.5 MG Injection [Risperdal]
risperidone
RxCUI: 706825
What the CMS Formulary Data Shows for risperidone 12.5 MG Injection [Risperdal]
Per the CMS 2026 Part D formulary file, risperidone 12.5 MG Injection [Risperdal] (RxNorm concept RXCUI 706825, 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 4, with a cross-plan average of Tier 3.8.
Real-world access to risperidone 12.5 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. 91.7% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 478,904 Part D beneficiaries filled risperidone 12.5 MG Injection [Risperdal] in 2023, with total plan-and-beneficiary spending of $60,762,995 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 12.5 MG Injection [Risperdal] today.
Coverage Details
- Formularies covering
- 24
- Plans covering
- 1,341
- Coverage rate
- 26.5%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 4.2% of formularies
- Step therapy required
- 8.3% of formularies
- Quantity limits
- 91.7% of formularies
2023 Medicare Spending
- Beneficiaries
- 478,904
- Total spending
- $60,762,995
- Avg per beneficiary
- $126.88
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering risperidone 12.5 MG Injection [Risperdal]
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Wellcare Simple (HMO-POS) | WELLCARE OF CONNECTICUT, INC. | T4 | No | No | $0 | CT |
| Wellcare Giveback (HMO-POS) | WELLCARE OF CONNECTICUT, INC. | T4 | No | No | $0 | CT |
Medicare Advantage Plans (MA-PD) Covering risperidone 12.5 MG Injection [Risperdal]
98 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 |
| Wellcare Simple (HMO-POS) | COORDINATED CARE OF WASHINGTON, INC. | T4 | No | $0 | WA |
| Wellcare Simple Open (PPO) | WELLCARE OF MISSISSIPPI, INC. | T4 | No | $0 | MS |
| Wellcare Simple Open (PPO) | WELLCARE OF GEORGIA, INC. | T4 | No | $0 | GA |
| Wellcare Simple (HMO) | WELLCARE OF TEXAS, INC. | T4 | No | $0 | TX |
| Wellcare Simple (HMO) | WELLCARE OF TEXAS, INC. | T4 | No | $0 | TX |
| Wellcare Simple (HMO) | WELLCARE OF TEXAS, INC. | T4 | No | $0 | TX |
| Wellcare Simple (HMO) | WELLCARE OF TEXAS, INC. | T4 | No | $0 | TX |
| Wellcare Simple Open (PPO) | WELLCARE HEALTH INSURANCE COMPANY OF AMERICA | T4 | No | $0 | AR |
| Wellcare Simple (HMO) | HEALTH NET OF ARIZONA, INC. | T4 | No | $0 | AZ |
| Wellcare Simple (HMO) | HEALTH NET OF ARIZONA, INC. | T4 | No | $0 | AZ |
| Wellcare Simple Value (HMO) | HEALTH NET OF ARIZONA, INC. | T4 | No | $0 | AZ |
| Wellcare Simple (HMO-POS) | HEALTH NET OF ARIZONA, INC. | T4 | No | $0 | NV |
| Wellcare Simple (HMO-POS) | HEALTH NET OF ARIZONA, INC. | T4 | No | $0 | NV |
| Wellcare Low Premium (HMO) | HEALTH NET OF CALIFORNIA, INC. | T4 | No | $0 | CA |
| Wellcare Simple Focus (HMO) | HEALTH NET OF CALIFORNIA, INC. | T4 | No | $0 | CA |
| Wellcare Simple Focus (HMO) | HEALTH NET OF CALIFORNIA, INC. | T4 | No | $0 | CA |
| Wellcare Low Premium (HMO) | HEALTH NET OF CALIFORNIA, INC. | T4 | No | $0 | CA |
| Wellcare Low Premium (HMO) | HEALTH NET OF CALIFORNIA, INC. | T4 | No | $0 | CA |
| Wellcare Simple (HMO-POS) | BUCKEYE COMMUNITY HEALTH PLAN, INC. | T4 | No | $0 | OH |
| Wellcare Low Premium (HMO-POS) | WELLCARE HEALTH PLANS OF NEW JERSEY, INC. | T4 | No | $0 | NJ |
| Wellcare Giveback (HMO-POS) | WELLCARE HEALTH PLANS OF NEW JERSEY, INC. | T4 | No | $0 | NJ |
| Wellcare Simple (HMO-POS) | WELLCARE HEALTH PLANS OF NEW JERSEY, INC. | T4 | No | $0 | NJ |
| Wellcare Simple (HMO) | Sunshine State Health Plan, Inc. | T4 | No | $0 | FL |
| Wellcare Simple (HMO) | Sunshine State Health Plan, Inc. | T4 | No | $0 | FL |
| Wellcare Simple (HMO) | Sunshine State Health Plan, Inc. | T4 | No | $0 | FL |
| Wellcare Simple (HMO) | Sunshine State Health Plan, Inc. | T4 | No | $0 | FL |
| Wellcare Simple (HMO) | Sunshine State Health Plan, Inc. | T4 | No | $0 | FL |
| Wellcare Simple (HMO) | Sunshine State Health Plan, Inc. | T4 | No | $0 | FL |
| Wellcare Simple (HMO) | Sunshine State Health Plan, Inc. | T4 | No | $0 | FL |
| Wellcare Simple (HMO-POS) | WELLCARE OF GEORGIA, INC. | T4 | No | $0 | GA |
| Wellcare Simple (HMO-POS) | WELLCARE OF GEORGIA, INC. | T4 | No | $0 | GA |
| Wellcare Simple (HMO-POS) | WELLCARE OF GEORGIA, INC. | T4 | No | $0 | GA |
| Wellcare Simple (HMO-POS) | WELLCARE OF GEORGIA, INC. | T4 | No | $0 | GA |
| Wellcare Giveback (HMO-POS) | NEBRASKA TOTAL CARE, INC. | T4 | No | $0 | NE |
| Wellcare Simple (HMO-POS) | NEBRASKA TOTAL CARE, INC. | T4 | No | $0 | NE |
| Wellcare Simple Open (PPO) | NEBRASKA TOTAL CARE, INC. | T4 | No | $0 | NE |
| Wellcare Low Premium (HMO-POS) | HARMONY HEALTH PLAN, INC. | T4 | No | $0 | MS |
| Wellcare Simple Preferred (HMO-POS) | HARMONY HEALTH PLAN, INC. | T4 | No | $0 | AR |
| Wellcare Simple (HMO-POS) | HARMONY HEALTH PLAN, INC. | T4 | No | $0 | MS |
| Wellcare Simple (HMO-POS) | HARMONY HEALTH PLAN, INC. | T4 | No | $0 | MS |
| Wellcare Simple (HMO-POS) | HARMONY HEALTH PLAN, INC. | T4 | No | $0 | TN |
| Wellcare Simple Value (HMO-POS) | HARMONY HEALTH PLAN, INC. | T4 | No | $0 | IL |
| Wellcare Simple (HMO-POS) | HOME STATE HEALTH PLAN, INC. | T4 | No | $0 | MO |
| Wellcare Simple (HMO-POS) | WELLCARE OF IOWA, INC. | T4 | No | $0 | IA |
Frequently Asked Questions
Is risperidone 12.5 MG Injection [Risperdal] covered by Medicare Part D?
Yes, risperidone 12.5 MG Injection [Risperdal] is covered by 1,341 Medicare Part D plans (26.5% of all Part D formularies).
What tier is risperidone 12.5 MG Injection [Risperdal] on Medicare Part D plans?
risperidone 12.5 MG Injection [Risperdal] averages Tier 3.8 across Part D plans, ranging from Tier 1 to Tier 4.
Does risperidone 12.5 MG Injection [Risperdal] require prior authorization?
4.2% of Part D formularies require prior authorization for risperidone 12.5 MG Injection [Risperdal]. Step therapy: 8.3%. Quantity limits: 91.7%.
How much does Medicare spend on risperidone 12.5 MG Injection [Risperdal]?
In 2023, total Medicare Part D spending on risperidone 12.5 MG Injection [Risperdal] was $60,762,995, covering 478,904 beneficiaries. The average spend per beneficiary was $126.88.
Read our methodology - how this data is sourced, computed, and verified.