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Lisdexamfetamine is the generic ingredient; brand versions: Vyvanse. What agents check before quoting it: how many 2026 Part D plans cover it, on which tier, with what restrictions and copays, by plan type, carrier and state.
In 2026, 2,710 of 5,496 Medicare Part D and Medicare Advantage drug plans (49.3%) list Lisdexamfetamine on their formulary, across 105 of 328 formularies. The most common placement is tier 4 (2,554 plans, 94.2% of those covering it). 275 of the covering plans require prior authorization (10.1%), 27 step therapy and 1,704 a quantity limit.
339 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $100, 42 of them $0; 2,371 charge coinsurance instead — median 29% of the drug's cost. Once a member's out-of-pocket drug spending reaches $2,100 in 2026, covered drugs cost $0 for the rest of the year.
2025: 2,928 of 5,631 plans covered it (52%); 2026: 2,710 of 5,496 (49.3%).
Of 4,368 plans offered in both years, 99 added it to the formulary and 79 dropped it.
Among plans covering it both years, 189 moved it to a higher tier and 2 to a lower one; 1 added prior authorization and 0 removed it.
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).
Price Lisdexamfetamine and the rest of a client's list on every plan in their county.
Estimate Lisdexamfetamine 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 09/16/2026). CMS formulary data.