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Santyl Part D coverage 2027

Santyl is a brand of collagenase. 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.

Coverage at a glance

In 2027, 5,399 of 5,492 Medicare Part D and Medicare Advantage drug plans (98.3%) list Santyl on their formulary, across 282 of 286 formularies. The most common placement is tier 4 (4,573 plans, 84.7% of those covering it). 2,573 of the covering plans require prior authorization (47.7%), 0 step therapy and 5,204 a quantity limit.

What a 30-day fill costs

419 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $45, 88 of them $0; 4,980 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.

What changed since 2026

2026: 5,383 of 5,496 plans covered it (97.9%); 2027: 5,399 of 5,492 (98.3%).

Of 4,367 plans offered in both years, 5 added it to the formulary and 0 dropped it.

Among plans covering it both years, 180 moved it to a higher tier and 164 to a lower one; 538 added prior authorization and 19 removed it.

Tier placement

By plan type

By carrier

By state

Medicare usage

Medicare Part D paid for 284,414 30-day fills of Santyl in 2024 for about 139,110 enrollees, at an average total cost of $631.23 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).

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.