Medicare Part D coverage · sapropterin dihydrochloride · RxCUI 1653221

sapropterin dihydrochloride 500 MG Powder for Oral Solution [Kuvan]

Per the CMS 2026 Part D formulary file, sapropterin dihydrochloride 500 MG Powder for Oral Solution [Kuvan] is covered by 2 Medicare Part D plans (0% of enrollable products), averaging Tier 1, with prior authorization required on 100% of covering formularies.

0%
Plan coverage
2
Plans covering
T1
Avg tier
100%
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 sapropterin dihydrochloride 500 MG Powder for Oral Solution [Kuvan]

Per the CMS 2026 Part D formulary file, sapropterin dihydrochloride 500 MG Powder for Oral Solution [Kuvan] (RxNorm concept RXCUI 1653221, generic name sapropterin dihydrochloride) appears on 1 distinct formulary file spanning 2 Medicare Part D plan offerings - 0% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 1, with a cross-plan average of Tier 1.

Real-world access to sapropterin dihydrochloride 500 MG Powder for Oral Solution [Kuvan] depends on utilization management as much as tier placement: 100% 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 [Kuvan] 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 [Kuvan] today.

Coverage Details

Formularies covering
1
Plans covering
2
Coverage rate
0%
Tier range
Tier 1, Preferred Generic
Average tier
Tier 1, Preferred Generic

Restrictions

Prior authorization required
100% 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

2 plans
Tier 1, Preferred Generic

Medicare Advantage Plans (MA-PD) Covering sapropterin dihydrochloride 500 MG Powder for Oral Solution [Kuvan]

2 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 Yes $0 NY
Hamaspik Medicare Select (HMO D-SNP) Hamaspik, Inc. T1 Yes $34.50 NY

Frequently Asked Questions

Is sapropterin dihydrochloride 500 MG Powder for Oral Solution [Kuvan] covered by Medicare Part D?

Yes, sapropterin dihydrochloride 500 MG Powder for Oral Solution [Kuvan] is covered by 2 Medicare Part D plans (0% of all Part D formularies).

What tier is sapropterin dihydrochloride 500 MG Powder for Oral Solution [Kuvan] on Medicare Part D plans?

sapropterin dihydrochloride 500 MG Powder for Oral Solution [Kuvan] averages Tier 1 across Part D plans, ranging from Tier 1 to Tier 1.

Does sapropterin dihydrochloride 500 MG Powder for Oral Solution [Kuvan] require prior authorization?

100% of Part D formularies require prior authorization for sapropterin dihydrochloride 500 MG Powder for Oral Solution [Kuvan]. Step therapy: 0%. Quantity limits: 0%.

How much does Medicare spend on sapropterin dihydrochloride 500 MG Powder for Oral Solution [Kuvan]?

In 2023, total Medicare Part D spending on sapropterin dihydrochloride 500 MG Powder for Oral Solution [Kuvan] 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

Similar prior-authorization rate

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