theophylline 300 MG Extended Release Oral Capsule [Theo-24]

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theophylline

RxCUI: 844591

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.
13.7%
Plan Coverage
693
Plans Covering
T3.4
Avg Tier
0%
Prior Auth Required

What the CMS Formulary Data Shows for theophylline 300 MG Extended Release Oral Capsule [Theo-24]

Per the CMS 2026 Part D formulary file, theophylline 300 MG Extended Release Oral Capsule [Theo-24] (RxNorm concept RXCUI 844591, generic name theophylline) appears on 27 distinct formulary files spanning 693 Medicare Part D plan offerings - 13.7% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 3.4.

Real-world access to theophylline 300 MG Extended Release Oral Capsule [Theo-24] depends on utilization management as much as tier placement: 0% 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 39,063 Part D beneficiaries filled theophylline 300 MG Extended Release Oral Capsule [Theo-24] in 2023, with total plan-and-beneficiary spending of $24,909,786 and an average per-beneficiary annual cost of $637.68. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry theophylline 300 MG Extended Release Oral Capsule [Theo-24] today.

Coverage Details

Formularies covering
27
Plans covering
693
Coverage rate
13.7%
Tier range
Tier 1 – Tier 4
Average tier
Tier 3, Preferred Brand

Restrictions

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

2023 Medicare Spending

Beneficiaries
39,063
Total spending
$24,909,786
Avg per beneficiary
$637.68

Tier Distribution Across Plans

3 plans
Tier 1, Preferred Generic
97 plans
Tier 2, Generic

Medicare Advantage Plans (MA-PD) Covering theophylline 300 MG Extended Release Oral Capsule [Theo-24]

100 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 No $0 NY
Community Care's Partnership Program (HMO D-SNP) COMMUNITY CARE HEALTH PLAN, INC. T1 No $0 WI
Hamaspik Medicare Select (HMO D-SNP) HAMASPIK, INC. T1 No $34.50 NY
MMM Supremo (HMO C-SNP) MMM HEALTHCARE, LLC T2 No $0 PR
MMM Diamante Platino (HMO D-SNP) MMM HEALTHCARE, LLC T2 No $0 PR
MMM Unico (HMO-POS) MMM HEALTHCARE, LLC T2 No $0 PR
MMM Elite (HMO-POS) MMM HEALTHCARE, LLC T2 No $0 PR
MMM Deluxe (HMO-POS) MMM HEALTHCARE, LLC T2 No $0 PR
MMM Dorado Platino (HMO D-SNP) MMM HEALTHCARE, LLC T2 No $0 PR
PMC Premier Platino (HMO D-SNP) MMM HEALTHCARE, LLC T2 No $0 PR
PMC Max (HMO-POS) MMM HEALTHCARE, LLC T2 No $0 PR
MMM Plenitud (HMO-POS) MMM HEALTHCARE, LLC T2 No $0 PR
MMM Valioso (HMO-POS) MMM HEALTHCARE, LLC T2 No $0 PR
MMM Combo Platino (HMO D-SNP) MMM HEALTHCARE, LLC T2 No $0 PR
MMM Flexi Platino (HMO D-SNP) MMM HEALTHCARE, LLC T2 No $0 PR
MMM Grandioso (HMO-POS) MMM HEALTHCARE, LLC T2 No $0 PR
MMM Mega Flex (HMO-POS) MMM HEALTHCARE, LLC T2 No $0 PR
MMM Relax Platino (HMO D-SNP) MMM HEALTHCARE, LLC T2 No $0 PR
MMM Balance (HMO-POS) MMM HEALTHCARE, LLC T2 No $0 PR
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Solano (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Inland Empire (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Ventura (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Kern (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Kern (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage San Diego (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Stanis (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Fresno (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Santa Cruz (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Alameda (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic SF (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Solano (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Advantage Inland Empire Value (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage San Diego Value (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Ventura Value (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Core DM (HMO) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Dual Essential (HMO D-SNP) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Silver DM (HMO-POS) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Core South (HMO) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Core North (HMO) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) KAISER FOUNDATION HP OF CO T2 No $0 CO

Frequently Asked Questions

Is theophylline 300 MG Extended Release Oral Capsule [Theo-24] covered by Medicare Part D?

Yes, theophylline 300 MG Extended Release Oral Capsule [Theo-24] is covered by 693 Medicare Part D plans (13.7% of all Part D formularies).

What tier is theophylline 300 MG Extended Release Oral Capsule [Theo-24] on Medicare Part D plans?

theophylline 300 MG Extended Release Oral Capsule [Theo-24] averages Tier 3.4 across Part D plans, ranging from Tier 1 to Tier 4.

Does theophylline 300 MG Extended Release Oral Capsule [Theo-24] require prior authorization?

0% of Part D formularies require prior authorization for theophylline 300 MG Extended Release Oral Capsule [Theo-24]. Step therapy: 0%. Quantity limits: 0%.

How much does Medicare spend on theophylline 300 MG Extended Release Oral Capsule [Theo-24]?

In 2023, total Medicare Part D spending on theophylline 300 MG Extended Release Oral Capsule [Theo-24] was $24,909,786, covering 39,063 beneficiaries. The average spend per beneficiary was $637.68.

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