12 HR carbamazepine 100 MG Extended Release Oral Capsule [Equetro]
carbamazepine
RxCUI: 672908
What the CMS Formulary Data Shows for 12 HR carbamazepine 100 MG Extended Release Oral Capsule [Equetro]
Per the CMS 2026 Part D formulary file, 12 HR carbamazepine 100 MG Extended Release Oral Capsule [Equetro] (RxNorm concept RXCUI 672908, generic name carbamazepine) appears on 18 distinct formulary files spanning 67 Medicare Part D plan offerings - 1.3% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 3.7.
Real-world access to 12 HR carbamazepine 100 MG Extended Release Oral Capsule [Equetro] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 11.1% require step therapy. 11.1% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 435 Part D beneficiaries filled 12 HR carbamazepine 100 MG Extended Release Oral Capsule [Equetro] in 2023, with total plan-and-beneficiary spending of $1,205,614 and an average per-beneficiary annual cost of $2,771.53. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 12 HR carbamazepine 100 MG Extended Release Oral Capsule [Equetro] today.
Coverage Details
- Formularies covering
- 18
- Plans covering
- 67
- Coverage rate
- 1.3%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 11.1% of formularies
- Quantity limits
- 11.1% of formularies
2023 Medicare Spending
- Beneficiaries
- 435
- Total spending
- $1,205,614
- Avg per beneficiary
- $2,771.53
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering 12 HR carbamazepine 100 MG Extended Release Oral Capsule [Equetro]
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP) | HM HEALTH INSURANCE COMPANY | T4 | No | No | $164.80 | - |
| Blue Rx PDP Plus (PDP) | HM HEALTH INSURANCE COMPANY | T4 | No | No | $193.20 | - |
Medicare Advantage Plans (MA-PD) Covering 12 HR carbamazepine 100 MG Extended Release Oral Capsule [Equetro]
65 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| SeniorCare Complete (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | ALAMEDA ALLIANCE FOR HEALTH | T1 | No | $0 | CA |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Flex (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Active (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Select Health Medicare Wellness (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Medicare BlueEssential (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Medicare BlueActive (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Medicare BlueVital (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Univera SeniorChoice Basic (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Univera SeniorChoice Extra (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Medicare Blue Choice Core (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Univera Medicare Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T4 | No | $0 | NY |
| Medicare Blue Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T4 | No | $0 | NY |
| Troy Medicare (HMO) | TROY HEALTH, INC. | T4 | No | $0 | NC |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | TROY HEALTH, INC. | T4 | No | $0 | NC |
| Contra Costa Health Care Plus (HMO D-SNP) | CONTRA COSTA COUNTY MEDICAL SERVICE DBA CONTRA COSTA HEALTH | T4 | No | $0 | CA |
| Keystone First VIP Choice (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T4 | No | $0 | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T4 | No | $0 | PA |
| First Choice VIP Care (HMO D-SNP) | SELECT HEALTH OF SOUTH CAROLINA, INC. | T4 | No | $0 | SC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T4 | No | $0 | DE |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T4 | No | $0 | DE |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS FLORIDA INC | T4 | No | $0 | FL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS LOUISIANA, INC. | T4 | No | $0 | LA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS NORTH CAROLINA, INC. | T4 | No | $0 | NC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH MICHIGAN, INC. | T4 | No | $0 | MI |
| Healthy Mississippi Premier Advantage (HMO-POS) | Healthy Mississippi, Inc. | T4 | No | $0 | MS |
| CDPHP $0 Medicare Rx (HMO) | CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Univera SeniorChoice Core (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $33.00 | NY |
| Univera SeniorChoice Advanced (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $36.90 | NY |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | No | $47.00 | PA |
| Medicare BlueClassic (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $51.00 | NY |
| Security Blue HMO-POS Standard (HMO-POS) | HIGHMARK CHOICE COMPANY | T4 | No | $51.80 | PA |
| Univera SeniorChoice Secure (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $54.90 | NY |
| Medicare BlueBalanced (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $55.00 | NY |
| Medicare Blue Choice Prime (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $55.00 | NY |
| Univera SeniorChoice Value Plus (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $58.60 | NY |
| Keystone 65 Preferred Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | No | $59.70 | PA |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | No | $63.50 | PA |
Frequently Asked Questions
Is 12 HR carbamazepine 100 MG Extended Release Oral Capsule [Equetro] covered by Medicare Part D?
Yes, 12 HR carbamazepine 100 MG Extended Release Oral Capsule [Equetro] is covered by 67 Medicare Part D plans (1.3% of all Part D formularies).
What tier is 12 HR carbamazepine 100 MG Extended Release Oral Capsule [Equetro] on Medicare Part D plans?
12 HR carbamazepine 100 MG Extended Release Oral Capsule [Equetro] averages Tier 3.7 across Part D plans, ranging from Tier 1 to Tier 4.
Does 12 HR carbamazepine 100 MG Extended Release Oral Capsule [Equetro] require prior authorization?
0% of Part D formularies require prior authorization for 12 HR carbamazepine 100 MG Extended Release Oral Capsule [Equetro]. Step therapy: 11.1%. Quantity limits: 11.1%.
How much does Medicare spend on 12 HR carbamazepine 100 MG Extended Release Oral Capsule [Equetro]?
In 2023, total Medicare Part D spending on 12 HR carbamazepine 100 MG Extended Release Oral Capsule [Equetro] was $1,205,614, covering 435 beneficiaries. The average spend per beneficiary was $2,771.53.
Read our methodology - how this data is sourced, computed, and verified.