varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya]
varenicline
RxCUI: 2572371
What the CMS Formulary Data Shows for varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya]
Per the CMS 2026 Part D formulary file, varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya] (RxNorm concept RXCUI 2572371, generic name varenicline) appears on 40 distinct formulary files spanning 986 Medicare Part D plan offerings - 19.5% 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 3.6.
Real-world access to varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya] depends on utilization management as much as tier placement: 5% of covering formularies require prior authorization. 7.5% require step therapy. 82.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 197,586 Part D beneficiaries filled varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya] in 2023, with total plan-and-beneficiary spending of $189,563,599 and an average per-beneficiary annual cost of $959.40. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya] today.
Coverage Details
- Formularies covering
- 40
- Plans covering
- 986
- Coverage rate
- 19.5%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 5% of formularies
- Step therapy required
- 7.5% of formularies
- Quantity limits
- 82.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 197,586
- Total spending
- $189,563,599
- Avg per beneficiary
- $959.40
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya]
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T4 | No | No | $0 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T4 | No | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya]
98 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $0 | IN |
| Provider Partners Maryland Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $0 | MD |
| Provider Partners Missouri Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $0 | MO |
| Mass General Brigham SCO (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | No | $0 | MA |
| Tufts Health One Care (HMO D-SNP) | TUFTS HEALTH PUBLIC PLANS, INC. | T1 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | TUFTS HEALTH PUBLIC PLANS, INC. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION | T1 | No | $0 | MA |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC. | T1 | No | $4.80 | TX |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS | T1 | No | $15.20 | IL |
| Provider Partners Maryland Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $31.20 | MD |
| Provider Partners Maryland Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $31.20 | MD |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $32.70 | PA |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $32.70 | PA |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $36.20 | NC |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $36.20 | NC |
| Provider Partners Indiana Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $38.40 | IN |
| Provider Partners Indiana Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $38.40 | IN |
| Provider Partners Kentucky Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF KENTUCKY | T1 | No | $38.40 | KY |
| Provider Partners Missouri Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $43.00 | MO |
| Provider Partners Missouri Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $43.00 | MO |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T3 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | UT |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | NV |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | CO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | CO |
| Select Health Medicare Flex (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | CO |
| Select Health Medicare Active (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T3 | No | $0 | NV |
| Select Health Medicare Wellness (HMO) | SELECTHEALTH, INC. | T3 | No | $0 | NV |
| Healthy Mississippi Premier Advantage (HMO-POS) | Healthy Mississippi, Inc. | T3 | No | $0 | MS |
| UHC Dual Complete IA-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | IA |
| UHC Dual Complete MO-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | MO |
| UHC Dual Complete NE-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | NE |
| UHC Dual Complete KS-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | KS |
| UHC Dual Complete MO-S3 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | MO |
| UHC Dual Complete KS-Q1 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | KS |
| UHC Dual Complete TN-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T4 | No | $0 | TN |
| UHC Dual Complete TN-Y001 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T4 | No | $0 | TN |
| UHC Dual Complete TN-Y2 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T4 | No | $0 | TN |
| AARP Medicare Advantage from UHC MI-0001 (PPO) | UNITEDHEALTHCARE INSURANCE COMPANY | T4 | No | $0 | MI |
Frequently Asked Questions
Is varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya] covered by Medicare Part D?
Yes, varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya] is covered by 986 Medicare Part D plans (19.5% of all Part D formularies).
What tier is varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya] on Medicare Part D plans?
varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya] averages Tier 3.6 across Part D plans, ranging from Tier 1 to Tier 4.
Does varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya] require prior authorization?
5% of Part D formularies require prior authorization for varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya]. Step therapy: 7.5%. Quantity limits: 82.5%.
How much does Medicare spend on varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya]?
In 2023, total Medicare Part D spending on varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya] was $189,563,599, covering 197,586 beneficiaries. The average spend per beneficiary was $959.40.
Read our methodology - how this data is sourced, computed, and verified.