Medicare Part D coverage · risperidone · RxCUI 706825
risperidone 12.5 MG Injection [Risperdal]
Per the CMS 2026 Part D formulary file, risperidone 12.5 MG Injection [Risperdal] is covered by 1,341 Medicare Part D plans (26.5% of enrollable products), averaging Tier 3.8, with prior authorization required on 4.2% of covering formularies.
- 26.5%
- Plan coverage
- 1,341
- Plans covering
- T3.8
- Avg tier
- 4.2%
- Prior auth required
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 $60,762,873 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 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
- $60,762,873
- Avg per beneficiary
- $126.88
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering risperidone 12.5 MG Injection [Risperdal]
100 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 |
Show the next 30 plans
| 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) | Wellcare OF Connecticut, Inc. | T4 | No | $0 | CT |
| Wellcare Giveback (HMO-POS) | Wellcare OF Connecticut, Inc. | T4 | No | $0 | CT |
| 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 |
Showing top 50 of 100 plans.
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 $60,762,873, 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
- fingolimod 0.5 MG Oral Capsule T3.8
- alanine 5.4 MG/ML / arginine 12 MG/ML / aspartate 3.2 MG/ML / cysteine 0.16 MG/ML / glutamate 5 MG/ML / glycine 3.6 MG/ML / histidine 4.8 MG/ML / isoleucine 8.2 MG/ML / leucine 14 MG/ML / lysine 8.2 MG/ML / methionine 3.4 MG/ML / phenylalanine 4.8 MG/ML / proline 6.8 MG/ML / serine 3.8 MG/ML / taurine 0.25 MG/ML / threonine 4.2 MG/ML / tryptophan 2 MG/ML / tyrosine 2.4 MG/ML / valine 7.8 MG/ML Injectable Solution [PremaSol] T3.8
- ledipasvir 90 MG / sofosbuvir 400 MG Oral Tablet T3.8
- 1.7 ML denosumab-bnht 70 MG/ML Injection [Bomyntra] T3.8
- dapsone 0.05 MG/MG Topical Gel T3.8
- 1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia] T3.8
Similar prior-authorization rate
- phenytoin 25 MG/ML Oral Suspension [Dilantin] 4.2% PA
- tramadol hydrochloride 100 MG Oral Tablet 4.3% PA
- 12 HR clonidine hydrochloride 0.1 MG Extended Release Oral Tablet 4.3% PA
- estrogens, conjugated (USP) 0.3 MG Oral Tablet 4.3% PA
- 1000 ML potassium chloride 0.02 MEQ/ML / sodium chloride 9 MG/ML Injection 4.3% PA
- insulin lispro 100 UNT/ML Injectable Solution [Humalog] 4.3% PA