sapropterin dihydrochloride 500 MG Powder for Oral Solution [Kuvan]
sapropterin dihydrochloride
RxCUI: 1653221
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
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.