Medicare Part D coverage · sapropterin dihydrochloride · RxCUI 2621237
sapropterin dihydrochloride 500 MG Powder for Oral Solution [Javygtor]
Per the CMS 2026 Part D formulary file, sapropterin dihydrochloride 500 MG Powder for Oral Solution [Javygtor] is covered by 1,593 Medicare Part D plans (31.5% of enrollable products), averaging Tier 4.3, with prior authorization required on 98.8% of covering formularies.
- 31.5%
- Plan coverage
- 1,593
- Plans covering
- T4.3
- Avg tier
- 98.8%
- Prior auth required
What the CMS Formulary Data Shows for sapropterin dihydrochloride 500 MG Powder for Oral Solution [Javygtor]
Per the CMS 2026 Part D formulary file, sapropterin dihydrochloride 500 MG Powder for Oral Solution [Javygtor] (RxNorm concept RXCUI 2621237, generic name sapropterin dihydrochloride) appears on 86 distinct formulary files spanning 1,593 Medicare Part D plan offerings - 31.5% 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 4.3.
Real-world access to sapropterin dihydrochloride 500 MG Powder for Oral Solution [Javygtor] depends on utilization management as much as tier placement: 98.8% 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 137 Part D beneficiaries filled sapropterin dihydrochloride 500 MG Powder for Oral Solution [Javygtor] in 2023, with total plan-and-beneficiary spending of $14,682,881 and an average per-beneficiary annual cost of $107,174.32. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry sapropterin dihydrochloride 500 MG Powder for Oral Solution [Javygtor] today.
Coverage Details
- Formularies covering
- 86
- Plans covering
- 1,593
- Coverage rate
- 31.5%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 98.8% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 137
- Total spending
- $14,682,881
- Avg per beneficiary
- $107,174.32
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering sapropterin dihydrochloride 500 MG Powder for Oral Solution [Javygtor]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | Yes | $0 | NY |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | Yes | $0 | CA |
| 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 |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
Show the next 30 plans
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | Yes | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $0 | DE |
| Florida Complete Care (HMO I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $13.10 | PA |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $17.60 | PA |
| Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $22.70 | NY |
| VIVA Medicare Extra Value (HMO D-SNP) | Viva Health, Inc. | T1 | Yes | $27.70 | AL |
| VIVA Medicare Extra Care (HMO D-SNP) | Viva Health, Inc. | T1 | Yes | $27.70 | AL |
| Highmark Health Options Duals Select (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $31.20 | DE |
| Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) | Elderplan, Inc. | T1 | Yes | $44.80 | NY |
| MetroPlus Platinum Plan (HMO) | Metroplus Health Plan, Inc. | T1 | Yes | $58.80 | NY |
| Freedom VIP Care (HMO C-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T4 | Yes | $0 | FL |
| Optimum Diamond Savings (HMO C-SNP) | Optimum Healthcare, Inc. | T4 | Yes | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T4 | Yes | $0 | FL |
| Optimum Diamond (HMO C-SNP) | Optimum Healthcare, Inc. | T4 | Yes | $0 | FL |
| Freedom Medi-Medi Partial (HMO D-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom Medi-Medi Full (HMO D-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Optimum Emerald Partial (HMO D-SNP) | Optimum Healthcare, Inc. | T4 | Yes | $0 | FL |
| Optimum Emerald Full (HMO D-SNP) | Optimum Healthcare, Inc. | T4 | Yes | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is sapropterin dihydrochloride 500 MG Powder for Oral Solution [Javygtor] covered by Medicare Part D?
Yes, sapropterin dihydrochloride 500 MG Powder for Oral Solution [Javygtor] is covered by 1,593 Medicare Part D plans (31.5% of all Part D formularies).
What tier is sapropterin dihydrochloride 500 MG Powder for Oral Solution [Javygtor] on Medicare Part D plans?
sapropterin dihydrochloride 500 MG Powder for Oral Solution [Javygtor] averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 5.
Does sapropterin dihydrochloride 500 MG Powder for Oral Solution [Javygtor] require prior authorization?
98.8% of Part D formularies require prior authorization for sapropterin dihydrochloride 500 MG Powder for Oral Solution [Javygtor]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on sapropterin dihydrochloride 500 MG Powder for Oral Solution [Javygtor]?
In 2023, total Medicare Part D spending on sapropterin dihydrochloride 500 MG Powder for Oral Solution [Javygtor] was $14,682,881, covering 137 beneficiaries. The average spend per beneficiary was $107,174.32.
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
- ceftaroline fosamil 400 MG Injection T4.3
- lomustine 100 MG Oral Capsule [Gleostine] T4.3
- 0.67 ML anakinra 149 MG/ML Prefilled Syringe [Kineret] T4.3
- sofosbuvir 400 MG / velpatasvir 100 MG Oral Tablet [Epclusa] T4.3
- 0.25 ML somatropin 4.8 MG/ML Prefilled Syringe [Genotropin] T4.3
- olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi] T4.3
Similar prior-authorization rate
- amphotericin B 50 MG Injection 98.8% PA
- alanine 27.6 MG/ML / arginine 19.6 MG/ML / aspartate 6 MG/ML / glutamate 10.2 MG/ML / glycine 20.6 MG/ML / histidine 11.8 MG/ML / isoleucine 10.8 MG/ML / leucine 10.8 MG/ML / lysine 13.5 MG/ML / methionine 7.6 MG/ML / phenylalanine 10 MG/ML / proline 13.4 MG/ML / serine 10.2 MG/ML / threonine 9.8 MG/ML / tryptophan 3.2 MG/ML / tyrosine 0.5 MG/ML / valine 14.4 MG/ML Injectable Solution [Prosol] 98.8% PA
- 0.4 ML abatacept 125 MG/ML Prefilled Syringe [Orencia] 98.8% PA
- 0.7 ML abatacept 125 MG/ML Prefilled Syringe [Orencia] 98.8% PA
- 1 ML abatacept 125 MG/ML Prefilled Syringe [Orencia] 98.8% PA
- risdiplam 0.75 MG/ML Oral Solution [Evrysdi] 98.8% PA