Does DrSelect (HMO) cover leuprolide?
DrSelect (HMO)
H4140-012-0 · MA_LOCAL · Medicare Part D
leuprolide
Do you get help with your Medicare drug costs?None of these
Optional. Some plans charge less at a preferred pharmacy. Enter your ZIP to see which pharmacies near you take this plan — pick yours and the price above is re-worked for it. Until you do, we show what a standard pharmacy costs. Nothing here is saved.
leuprolideunder DrSelect (HMO)
Covered — requires prior authorization
Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
$55per 30-day fill
Part D caps what you pay out of pocket at $2,100 for 2026. From the first fill — no deductible on this drug.
This plan charges the same at every pharmacy in its network — where you fill it will not change this figure.
Amount limit applies — how much depends on the strength you are prescribed — the cap for each one is listed below. You can still fill it; more than that needs your plan's approval, which your doctor's office requests.
- Tier
- Tier 4
- Approval first
- Required
- Try another first
- No
- Amount limit
- Varies by strength
Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 16, 2026 · CMS Part D monthly PUF. Reference information, not medical advice and not a price.
Covered forms and strengths (15)
- 0.25 ML leuprolide acetate 30 MG/ML Prefilled Syringe [Eligard]Tier 4Approval first1 syringe per 28 days
- 0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Eligard]Tier 4Approval first1 syringe per 168 days
- 0.375 ML leuprolide acetate 60 MG/ML Prefilled Syringe [Eligard]Tier 4Approval first1 syringe per 84 days
- 0.5 ML leuprolide acetate 60 MG/ML Prefilled Syringe [Eligard]Tier 4Approval first1 syringe per 112 days
- 1 ML leuprolide acetate 3.75 MG/ML Prefilled Syringe [Lupron]Tier 5Approval first1 syringe per 28 days
- 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron]Tier 5Approval first1 syringe per 28 days
- 1.5 ML leuprolide acetate 15 MG/ML Prefilled Syringe [Lupron]Tier 5Approval first1 syringe per 84 days
- 1.5 ML leuprolide acetate 30 MG/ML Prefilled Syringe [Lupron]Tier 5Approval first1 syringe per 168 days
- 1.5 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron]Tier 5Approval first1 syringe per 84 days
- 4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron]Tier 5Approval first1 syringe per 112 days
- leuprolide acetate 22.5 MG Injection [Lutrate]Tier 4Approval first1 unit per 84 days
- leuprolide acetate 5 MG/ML Injectable SolutionTier 4Approval first
- Pediatric 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron]Tier 5Approval first1 syringe per 28 days
- Pediatric 1.5 ML leuprolide acetate 30 MG/ML Prefilled Syringe [Lupron]Tier 5Approval first1 syringe per 90 days
- Pediatric 1.5 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron]Tier 5Approval first1 syringe per 28 days