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TIER PLANS TIER 1 (40mg total) $300 total for 8 week supply Monthly cost breakdown: $150 Recommended if new to treatment or for those on 2-5mg/week TIER 2 (60mg total) $375 total for 8 week supply Monthly cost breakdown: $187 Recommended for those on 6-7mg/week TIER 3 (80mg total) $450 total for 8 week supply Monthly cost breakdown: $225 Recommended for those on 8-10mg/week TIER 4 (136mg total) $595 total for 8 week supply Monthly cost breakdown: $297 Recommended for those on 11mg/week and up MONTHLY PLANS Monthly Starter Dose $189 total for one month supply Recommended if new to treatment or for those on doses of 5mg/week or less Monthly Mid Dose $225 total for one month supply Recommended for doses up to 8mg/week Monthly Advanced Dose $265 total for one month supply Recommended for doses of 9-10mg/week Monthly Advanced Plus Dose $335 total for one month supply Recommended for doses of 11mg/week and up Alchemist Pharmacy - Tirzepatide/Levocarnitine Injection Up to 90 days BUD

Comment: A commenter supported the proposal to assign CPT code 0620T to APC 1579 (New TechnologyLevel 42 ($30,001-$40,000)) with a payment rate of $35,000.50 for CY 2026 based on the application of the universal low volume APC policy

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