tesamorelin 11.6 MG Injection [Egrifta]
tesamorelin
RxCUI: 2719316
What the CMS Formulary Data Shows for tesamorelin 11.6 MG Injection [Egrifta]
Per the CMS 2026 Part D formulary file, tesamorelin 11.6 MG Injection [Egrifta] (RxNorm concept RXCUI 2719316, generic name tesamorelin) appears on 31 distinct formulary files spanning 211 Medicare Part D plan offerings - 4.2% 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 4.2.
Real-world access to tesamorelin 11.6 MG Injection [Egrifta] depends on utilization management as much as tier placement: 93.5% of covering formularies require prior authorization. 0% require step therapy. 38.7% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 653 Part D beneficiaries filled tesamorelin 11.6 MG Injection [Egrifta] in 2023, with total plan-and-beneficiary spending of $31,601,920 and an average per-beneficiary annual cost of $48,394.98. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry tesamorelin 11.6 MG Injection [Egrifta] today.
Coverage Details
- Formularies covering
- 31
- Plans covering
- 211
- Coverage rate
- 4.2%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 93.5% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 38.7% of formularies
2023 Medicare Spending
- Beneficiaries
- 653
- Total spending
- $31,601,920
- Avg per beneficiary
- $48,394.98
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering tesamorelin 11.6 MG Injection [Egrifta]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| SeniorCare Complete (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | ALAMEDA ALLIANCE FOR HEALTH | 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 |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T1 | Yes | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T1 | Yes | $17.00 | AZ |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| PHP (HMO C-SNP) | AIDS HEALTHCARE FOUNDATION | T4 | Yes | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS CHOICE | T4 | Yes | $0 | NY |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS CHOICE | T4 | Yes | $51.60 | NY |
| Network Health Select (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T5 | Yes | $0 | WI |
| Network Health Go (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T5 | Yes | $0 | WI |
| Network Health Anywhere (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T5 | Yes | $0 | WI |
| Network Health Choice (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T5 | Yes | $0 | WI |
| Network Health Zero (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T5 | Yes | $0 | WI |
| Troy Medicare (HMO) | TROY HEALTH, INC. | T5 | Yes | $0 | NC |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | TROY HEALTH, INC. | T5 | Yes | $0 | NC |
| Contra Costa Health Care Plus (HMO D-SNP) | CONTRA COSTA COUNTY MEDICAL SERVICE DBA CONTRA COSTA HEALTH | T5 | Yes | $0 | CA |
| SummaCare Medicare Topaz (HMO) | SUMMACARE INC. | T5 | Yes | $0 | OH |
| SummaCare Medicare Quartz (HMO) | SUMMACARE INC. | T5 | Yes | $0 | OH |
| Keystone First VIP Choice (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T5 | Yes | $0 | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T5 | Yes | $0 | PA |
| First Choice VIP Care (HMO D-SNP) | SELECT HEALTH OF SOUTH CAROLINA, INC. | T5 | Yes | $0 | SC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T5 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T5 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS FLORIDA INC | T5 | Yes | $0 | FL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS LOUISIANA, INC. | T5 | Yes | $0 | LA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH MICHIGAN, INC. | T5 | Yes | $0 | MI |
| Gold Heart & Diabetes (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T5 | Yes | $0 | FL |
| Gold Heart & Diabetes Complete (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T5 | Yes | $0 | FL |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T5 | Yes | $0 | FL |
| Gold Health (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T5 | Yes | $0 | FL |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T5 | Yes | $0 | FL |
| Gold Heart & Diabetes (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T5 | Yes | $0 | AZ |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T5 | Yes | $0 | AZ |
| Gold Heart & Diabetes (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T5 | Yes | $0 | AZ |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T5 | Yes | $0 | AZ |
| VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) | VILLAGE SENIOR SERVICES CORPORATION | T5 | Yes | $0 | NY |
| VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) | VILLAGE SENIOR SERVICES CORPORATION | T5 | Yes | $0 | NY |
| 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 |
Frequently Asked Questions
Is tesamorelin 11.6 MG Injection [Egrifta] covered by Medicare Part D?
Yes, tesamorelin 11.6 MG Injection [Egrifta] is covered by 211 Medicare Part D plans (4.2% of all Part D formularies).
What tier is tesamorelin 11.6 MG Injection [Egrifta] on Medicare Part D plans?
tesamorelin 11.6 MG Injection [Egrifta] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 5.
Does tesamorelin 11.6 MG Injection [Egrifta] require prior authorization?
93.5% of Part D formularies require prior authorization for tesamorelin 11.6 MG Injection [Egrifta]. Step therapy: 0%. Quantity limits: 38.7%.
How much does Medicare spend on tesamorelin 11.6 MG Injection [Egrifta]?
In 2023, total Medicare Part D spending on tesamorelin 11.6 MG Injection [Egrifta] was $31,601,920, covering 653 beneficiaries. The average spend per beneficiary was $48,394.98.
Read our methodology - how this data is sourced, computed, and verified.