Medicare Part D coverage · theophylline · RxCUI 844591
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] is covered by 693 Medicare Part D plans (13.7% of enrollable products), averaging Tier 3.4, with prior authorization required on 0% of covering formularies.
- 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
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 |
Show the next 30 plans
Showing top 50 of 100 plans.
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.
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
- imatinib 400 MG Oral Tablet T3.4
- 500 ML olive oil 160 MG/ML / soybean oil 40 MG/ML Injection [Clinolipid] T3.4
- triamterene 100 MG Oral Capsule T3.4
- 9 HR methylphenidate 1.11 MG/HR Transdermal System T3.4
- 24 HR morphine sulfate 60 MG Extended Release Oral Capsule T3.4
- amcinonide 0.001 MG/MG Topical Ointment T3.4