Medicare Part D coverage · tesamorelin · RxCUI 2719316
tesamorelin 11.6 MG Injection [Egrifta]
Per the CMS 2026 Part D formulary file, tesamorelin 11.6 MG Injection [Egrifta] is covered by 211 Medicare Part D plans (4.2% of enrollable products), averaging Tier 4.2, with prior authorization required on 93.5% of covering formularies.
- 4.2%
- Plan coverage
- 211
- Plans covering
- T4.2
- Avg tier
- 93.5%
- Prior auth required
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 |
Show the next 30 plans
| 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 |
Showing top 50 of 100 plans.
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.
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
- 24 HR selegiline 0.25 MG/HR Transdermal System [Emsam] T4.2
- lotilaner 2.5 MG/ML Ophthalmic Solution [Xdemvy] T4.2
- glutamine 5000 MG Powder for Oral Solution T4.2
- 1.7 ML denosumab-bbdz 70 MG/ML Injection [Wyost] T4.2
- {4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack] T4.2
- apremilast 20 MG Oral Tablet [Otezla] T4.2
Similar prior-authorization rate
- {84 (amoxicillin 500 MG Oral Capsule) / 28 (vonoprazan 20 MG Oral Tablet) } Pack [Voquezna 14 Day DualPak 20;500] 93.5% PA
- 2 ML lanadelumab-flyo 150 MG/ML Injection [Takhzyro] 93.5% PA
- levacetylleucine 1000 MG Granules for Oral Suspension [Aqneursa] 93.5% PA
- deferasirox 90 MG Oral Tablet 93.7% PA
- vonoprazan 10 MG Oral Tablet [Voquezna] 93.3% PA
- {4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) } Pack [Zeposia 7-Day Starter Pack] 93.3% PA