Medicare Part D coverage · sepiapterin · RxCUI 2723067

sepiapterin 1000 MG Oral Powder [Sephience]

Per the CMS 2026 Part D formulary file, sepiapterin 1000 MG Oral Powder [Sephience] is covered by 132 Medicare Part D plans (2.6% of enrollable products), averaging Tier 4, with prior authorization required on 75% of covering formularies.

2.6%
Plan coverage
132
Plans covering
T4
Avg tier
75%
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 sepiapterin 1000 MG Oral Powder [Sephience]

Per the CMS 2026 Part D formulary file, sepiapterin 1000 MG Oral Powder [Sephience] (RxNorm concept RXCUI 2723067, generic name sepiapterin) appears on 8 distinct formulary files spanning 132 Medicare Part D plan offerings - 2.6% 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.

Real-world access to sepiapterin 1000 MG Oral Powder [Sephience] depends on utilization management as much as tier placement: 75% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.

Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry sepiapterin 1000 MG Oral Powder [Sephience] today.

Coverage Details

Formularies covering
8
Plans covering
132
Coverage rate
2.6%
Tier range
Tier 1 – Tier 5
Average tier
Tier 4, Non-Preferred

Restrictions

Prior authorization required
75% of formularies
Step therapy required
0% of formularies
Quantity limits
0% of formularies

Tier Distribution Across Plans

2 plans
Tier 1, Preferred Generic
98 plans
Tier 5, Specialty

Medicare Advantage Plans (MA-PD) Covering sepiapterin 1000 MG Oral Powder [Sephience]

100 Medicare Advantage plans with Part D drug coverage include this drug.

Plan Insurer Tier PA Premium States
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
Health First Rewards H1099-014 (HMO) Health First Health Plans T5 Yes $0 FL
Health First SunSaver H1099-016 (HMO) Health First Health Plans T5 Yes $0 FL
Health First Complete Care H1099-023 (HMO) Health First Health Plans T5 Yes $0 FL
Health First Emerald Plus H1099-024 (HMO) Health First Health Plans T5 Yes $0 FL
Health First Premier Access H1099-025 (HMO-POS) Health First Health Plans T5 Yes $0 FL
Health First Emerald Plus H1099-026 (HMO) Health First Health Plans T5 Yes $0 FL
Health First Premier Access H1099-027 (HMO-POS) Health First Health Plans T5 Yes $0 FL
Health First Emerald Plus H1099-028 (HMO) Health First Health Plans T5 Yes $0 FL
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Solano (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Senior Advantage Inland Empire (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Senior Advantage Ventura (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Kern (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic Kern (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Senior Advantage San Diego (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Show the next 30 plans
Kaiser Permanente Senior Advantage Basic Stanis (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic Fresno (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Senior Advantage Santa Cruz (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic Alameda (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic SF (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic Solano (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Sr Advantage Inland Empire Value (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Senior Advantage San Diego Value (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Senior Advantage Ventura Value (HMO) Kaiser Foundation HP, Inc. T5 No $0 CA
Kaiser Permanente Senior Advantage Core DM (HMO) Kaiser Foundation HP OF Co T5 No $0 CO
Kaiser Permanente Dual Essential (HMO D-SNP) Kaiser Foundation HP OF Co T5 No $0 CO
Kaiser Permanente Senior Advantage Silver DM (HMO-POS) Kaiser Foundation HP OF Co T5 No $0 CO
Kaiser Permanente Senior Advantage Core South (HMO) Kaiser Foundation HP OF Co T5 No $0 CO
Kaiser Permanente Senior Advantage Core North (HMO) Kaiser Foundation HP OF Co T5 No $0 CO
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) Kaiser Foundation HP OF Co T5 No $0 CO
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) Kaiser Foundation HP OF Co T5 No $0 CO
Kaiser Permanente Senior Advantage Bronze DM (HMO-POS) Kaiser Foundation HP OF Co T5 No $0 CO
Kaiser Permanente Dual Complete (HMO D-SNP) Kaiser Foundation HP OF Co T5 No $0 CO
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) Kaiser Foundation HP OF GA, Inc. T5 No $0 GA
Kaiser Permanente Senior Advantage Basic 1 (HMO) Kaiser Foundation HP OF GA, Inc. T5 No $0 GA
Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP) Kaiser Foundation HP OF GA, Inc. T5 No $0 GA
Kaiser Permanente Senior Advantage Basic 2 (HMO) Kaiser Foundation HP OF GA, Inc. T5 No $0 GA
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) Kaiser Foundation HP OF GA, Inc. T5 No $0 GA
Kaiser Permanente Dual Complete (HMO D-SNP) Kaiser Foundation HP OF GA, Inc. T5 No $0 GA

Showing top 50 of 100 plans.

Frequently Asked Questions

Is sepiapterin 1000 MG Oral Powder [Sephience] covered by Medicare Part D?

Yes, sepiapterin 1000 MG Oral Powder [Sephience] is covered by 132 Medicare Part D plans (2.6% of all Part D formularies).

What tier is sepiapterin 1000 MG Oral Powder [Sephience] on Medicare Part D plans?

sepiapterin 1000 MG Oral Powder [Sephience] averages Tier 4 across Part D plans, ranging from Tier 1 to Tier 5.

Does sepiapterin 1000 MG Oral Powder [Sephience] require prior authorization?

75% of Part D formularies require prior authorization for sepiapterin 1000 MG Oral Powder [Sephience]. Step therapy: 0%. Quantity limits: 0%.

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.

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