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Cyproheptadine is a generic drug. What agents check before quoting it: how many 2027 Part D plans cover it, on which tier, with what restrictions and copays, by plan type, carrier and state.
In 2027, 3,007 of 5,492 Medicare Part D and Medicare Advantage drug plans (54.8%) list Cyproheptadine on their formulary, across 173 of 286 formularies. The most common placement is tier 3 (1,427 plans, 47.5% of those covering it). 2,213 of the covering plans require prior authorization (73.6%), 0 step therapy and 29 a quantity limit.
574 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $0, 321 of them $0; 2,433 charge coinsurance instead — median 25% of the drug's cost. Once a member's out-of-pocket drug spending reaches $2,400 in 2027, covered drugs cost $0 for the rest of the year.
2026: 3,130 of 5,496 plans covered it (57%); 2027: 3,007 of 5,492 (54.8%).
Of 4,367 plans offered in both years, 17 added it to the formulary and 173 dropped it.
Among plans covering it both years, 87 moved it to a higher tier and 240 to a lower one; 7 added prior authorization and 39 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 223 |
| Tier 2 | 442 |
| Tier 3 | 1,427 |
| Tier 4 | 915 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 96 of 323 | 29.7% | 97.9% |
| Medicare Advantage with drugs (MA-PD) | 1,735 of 3,200 | 54.2% | 73% |
| Special needs plans (SNP) | 1,176 of 1,969 | 59.7% | 72.4% |
| Carrier | Plans covering | Usual tier | Prior auth |
|---|---|---|---|
| Humana | 0 of 846 | No tier listed | 0 |
| UnitedHealthcare | 0 of 830 | No tier listed | 0 |
| Devoted Health | 728 of 728 | Tier 3 | 728 |
| Aetna Medicare | 631 of 631 | Tier 4 | 631 |
| Wellcare | 268 of 268 | Tier 3 | 268 |
| HealthSpring | 0 of 226 | No tier listed | 0 |
| Kaiser Permanente | 112 of 112 | Tier 2 | 0 |
| SCAN Health Plan | 83 of 83 | Tier 4 | 0 |
| Highmark Blue Cross Blue Shield or Highmark Blue Shield | 80 of 80 | Tier 2 | 80 |
| Alignment Health Plan | 0 of 77 | No tier listed | 0 |
| Anthem Blue Cross and Blue Shield | 74 of 74 | Tier 3 | 69 |
| Wellpoint | 63 of 63 | Tier 3 | 45 |
| Priority Health Medicare | 40 of 40 | Tier 4 | 0 |
| CarePlus Health Plans, Inc. | 0 of 37 | No tier listed | 0 |
| Zing Health | 36 of 36 | Tier 3 | 36 |
| Capital Blue Cross | 0 of 35 | No tier listed | 0 |
| Prominence Health Plan | 29 of 29 | Tier 2 | 29 |
| Medica | 0 of 27 | No tier listed | 0 |
| Anthem HealthKeepers | 26 of 26 | Tier 3 | 21 |
| Blue Cross Blue Shield of Michigan | 0 of 26 | No tier listed | 0 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 56 of 114 | 49.1% |
| Alaska | 3 of 9 | 33.3% |
| American Samoa | 0 of 1 | 0% |
| Arizona | 87 of 147 | 59.2% |
| Arkansas | 41 of 85 | 48.2% |
| California | 232 of 397 | 58.4% |
| Colorado | 56 of 106 | 52.8% |
| Connecticut | 37 of 54 | 68.5% |
| Delaware | 23 of 43 | 53.5% |
| District of Columbia | 6 of 12 | 50% |
| Florida | 289 of 545 | 53% |
| Georgia | 72 of 149 | 48.3% |
| Guam | 0 of 1 | 0% |
| Hawaii | 33 of 50 | 66% |
| Idaho | 14 of 45 | 31.1% |
| Illinois | 64 of 132 | 48.5% |
| Indiana | 79 of 138 | 57.2% |
| Iowa | 40 of 64 | 62.5% |
| Kansas | 43 of 84 | 51.2% |
| Kentucky | 52 of 121 | 43% |
| Louisiana | 53 of 125 | 42.4% |
| Maine | 24 of 52 | 46.2% |
| Maryland | 32 of 49 | 65.3% |
| Massachusetts | 70 of 89 | 78.7% |
| Michigan | 105 of 182 | 57.7% |
| Minnesota | 18 of 63 | 28.6% |
| Mississippi | 49 of 104 | 47.1% |
| Missouri | 90 of 170 | 52.9% |
| Montana | 4 of 27 | 14.8% |
| Nebraska | 27 of 51 | 52.9% |
| Nevada | 46 of 100 | 46% |
| New Hampshire | 8 of 25 | 32% |
| New Jersey | 42 of 73 | 57.5% |
| New Mexico | 18 of 68 | 26.5% |
| New York | 151 of 215 | 70.2% |
| North Carolina | 91 of 176 | 51.7% |
| North Dakota | 9 of 26 | 34.6% |
| Northern Mariana Islands | 0 of 1 | 0% |
| Ohio | 94 of 171 | 55% |
| Oklahoma | 27 of 81 | 33.3% |
| Oregon | 55 of 92 | 59.8% |
| Pennsylvania | 226 of 323 | 70% |
| Puerto Rico | 61 of 64 | 95.3% |
| Rhode Island | 9 of 29 | 31% |
| South Carolina | 44 of 89 | 49.4% |
| South Dakota | 13 of 30 | 43.3% |
| Tennessee | 72 of 156 | 46.2% |
| Texas | 210 of 407 | 51.6% |
| U.S. Virgin Islands | 0 of 1 | 0% |
| Utah | 22 of 53 | 41.5% |
| Vermont | 4 of 14 | 28.6% |
| Virginia | 59 of 144 | 41% |
| Washington | 66 of 114 | 57.9% |
| West Virginia | 36 of 69 | 52.2% |
| Wisconsin | 35 of 96 | 36.5% |
| Wyoming | 2 of 13 | 15.4% |
Medicare Part D paid for 304,351 30-day fills of Cyproheptadine in 2024 for about 72,646 enrollees, at an average total cost of $14.27 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Cyproheptadine and the rest of a client's list on every plan in their county.
Estimate Cyproheptadine costs by plan
Free tools for licensed insurance agents. Data from CMS public files; verify with plan documents before advising a client.
Counts are over every Medicare Advantage drug plan and stand-alone Part D plan in the CMS monthly formulary files, excluding employer plans. A plan counts as covering a drug when any strength or form of it is on the plan’s formulary; the tier, prior authorization, step therapy and quantity limit shown are the most favorable version on that formulary. Copays are for a 30-day supply at a preferred retail pharmacy after the deductible. This is a reference for licensed agents, not a plan recommendation; verify with the plan’s formulary before advising a client. Source: CMS Part D formulary files (release 10/08/2026). CMS formulary data.