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Lisdexamfetamine 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, 2,778 of 5,492 Medicare Part D and Medicare Advantage drug plans (50.6%) list Lisdexamfetamine on their formulary, across 90 of 286 formularies. The most common placement is tier 4 (2,368 plans, 85.2% of those covering it). 545 of the covering plans require prior authorization (19.6%), 12 step therapy and 1,754 a quantity limit.
186 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $15, 58 of them $0; 2,592 charge coinsurance instead — median 27% 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: 2,710 of 5,496 plans covered it (49.3%); 2027: 2,778 of 5,492 (50.6%).
Of 4,367 plans offered in both years, 241 added it to the formulary and 46 dropped it.
Among plans covering it both years, 13 moved it to a higher tier and 196 to a lower one; 0 added prior authorization and 0 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 50 |
| Tier 2 | 100 |
| Tier 3 | 260 |
| Tier 4 | 2,368 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 115 of 323 | 35.6% | 0% |
| Medicare Advantage with drugs (MA-PD) | 1,518 of 3,200 | 47.4% | 16.6% |
| Special needs plans (SNP) | 1,145 of 1,969 | 58.2% | 25.6% |
| Carrier | Plans covering | Usual tier | Prior auth |
|---|---|---|---|
| Humana | 0 of 846 | No tier listed | 0 |
| UnitedHealthcare | 796 of 830 | Tier 4 | 0 |
| Devoted Health | 446 of 728 | Tier 4 | 446 |
| Aetna Medicare | 611 of 631 | Tier 4 | 0 |
| Wellcare | 234 of 268 | Tier 3 | 0 |
| HealthSpring | 226 of 226 | Tier 4 | 0 |
| Kaiser Permanente | 112 of 112 | Tier 4 | 0 |
| SCAN Health Plan | 0 of 83 | No tier listed | 0 |
| Highmark Blue Cross Blue Shield or Highmark Blue Shield | 0 of 80 | No tier listed | 0 |
| Alignment Health Plan | 0 of 77 | No tier listed | 0 |
| Anthem Blue Cross and Blue Shield | 0 of 74 | No tier listed | 0 |
| Wellpoint | 0 of 63 | No tier listed | 0 |
| Priority Health Medicare | 0 of 40 | No tier listed | 0 |
| CarePlus Health Plans, Inc. | 0 of 37 | No tier listed | 0 |
| Zing Health | 6 of 36 | Tier 4 | 6 |
| Capital Blue Cross | 8 of 35 | Tier 4 | 0 |
| Prominence Health Plan | 0 of 29 | No tier listed | 0 |
| Medica | 0 of 27 | No tier listed | 0 |
| Anthem HealthKeepers | 0 of 26 | No tier listed | 0 |
| Blue Cross Blue Shield of Michigan | 0 of 26 | No tier listed | 0 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 81 of 114 | 71.1% |
| Alaska | 3 of 9 | 33.3% |
| American Samoa | 1 of 1 | 100% |
| Arizona | 64 of 147 | 43.5% |
| Arkansas | 45 of 85 | 52.9% |
| California | 140 of 397 | 35.3% |
| Colorado | 72 of 106 | 67.9% |
| Connecticut | 31 of 54 | 57.4% |
| Delaware | 23 of 43 | 53.5% |
| District of Columbia | 10 of 12 | 83.3% |
| Florida | 266 of 545 | 48.8% |
| Georgia | 95 of 149 | 63.8% |
| Guam | 1 of 1 | 100% |
| Hawaii | 26 of 50 | 52% |
| Idaho | 20 of 45 | 44.4% |
| Illinois | 72 of 132 | 54.5% |
| Indiana | 54 of 138 | 39.1% |
| Iowa | 40 of 64 | 62.5% |
| Kansas | 52 of 84 | 61.9% |
| Kentucky | 53 of 121 | 43.8% |
| Louisiana | 63 of 125 | 50.4% |
| Maine | 28 of 52 | 53.8% |
| Maryland | 28 of 49 | 57.1% |
| Massachusetts | 28 of 89 | 31.5% |
| Michigan | 49 of 182 | 26.9% |
| Minnesota | 18 of 63 | 28.6% |
| Mississippi | 63 of 104 | 60.6% |
| Missouri | 100 of 170 | 58.8% |
| Montana | 5 of 27 | 18.5% |
| Nebraska | 28 of 51 | 54.9% |
| Nevada | 44 of 100 | 44% |
| New Hampshire | 11 of 25 | 44% |
| New Jersey | 39 of 73 | 53.4% |
| New Mexico | 45 of 68 | 66.2% |
| New York | 127 of 215 | 59.1% |
| North Carolina | 96 of 176 | 54.5% |
| North Dakota | 10 of 26 | 38.5% |
| Northern Mariana Islands | 1 of 1 | 100% |
| Ohio | 85 of 171 | 49.7% |
| Oklahoma | 44 of 81 | 54.3% |
| Oregon | 47 of 92 | 51.1% |
| Pennsylvania | 110 of 323 | 34.1% |
| Puerto Rico | 3 of 64 | 4.7% |
| Rhode Island | 15 of 29 | 51.7% |
| South Carolina | 52 of 89 | 58.4% |
| South Dakota | 12 of 30 | 40% |
| Tennessee | 82 of 156 | 52.6% |
| Texas | 244 of 407 | 60% |
| U.S. Virgin Islands | 1 of 1 | 100% |
| Utah | 33 of 53 | 62.3% |
| Vermont | 3 of 14 | 21.4% |
| Virginia | 70 of 144 | 48.6% |
| Washington | 78 of 114 | 68.4% |
| West Virginia | 34 of 69 | 49.3% |
| Wisconsin | 49 of 96 | 51% |
| Wyoming | 3 of 13 | 23.1% |
Medicare Part D paid for 210,158 30-day fills of Lisdexamfetamine in 2024 for about 46,053 enrollees, at an average total cost of $210.98 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
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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.