12 HR tapentadol 200 MG Extended Release Oral Tablet [Nucynta]
tapentadol
RxCUI: 1149373
What the CMS Formulary Data Shows for 12 HR tapentadol 200 MG Extended Release Oral Tablet [Nucynta]
Per the CMS 2026 Part D formulary file, 12 HR tapentadol 200 MG Extended Release Oral Tablet [Nucynta] (RxNorm concept RXCUI 1149373, generic name tapentadol) appears on 1 distinct formulary file 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 5 to Tier 5, with a cross-plan average of Tier 5.
Real-world access to 12 HR tapentadol 200 MG Extended Release Oral Tablet [Nucynta] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 100% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 10,048 Part D beneficiaries filled 12 HR tapentadol 200 MG Extended Release Oral Tablet [Nucynta] in 2023, with total plan-and-beneficiary spending of $58,810,957 and an average per-beneficiary annual cost of $5,853.00. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 12 HR tapentadol 200 MG Extended Release Oral Tablet [Nucynta] today.
Coverage Details
- Formularies covering
- 1
- Plans covering
- 67
- Coverage rate
- 1.3%
- Tier range
- Tier 5, Specialty
- Average tier
- Tier 5, Specialty
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 100% of formularies
2023 Medicare Spending
- Beneficiaries
- 10,048
- Total spending
- $58,810,957
- Avg per beneficiary
- $5,853.00
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 12 HR tapentadol 200 MG Extended Release Oral Tablet [Nucynta]
67 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Alignment Health the ONE + Walgreens (HMO) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | Yes | $0 | AZ |
| Alignment Health the ONE + Walgreens (HMO) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | Yes | $0 | AZ |
| Alignment Health Heart & Diabetes (HMO C-SNP) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | Yes | $0 | AZ |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | Yes | $0 | AZ |
| Alignment Health My Choice (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Platinum + Instacart (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Heart & Diabetes (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health AllCare Preferred (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Platinum + Instacart (HMO-POS) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health My Choice (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Harmony (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Balance (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health the ONE (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health the ONE + Walgreens (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health CommUnity (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health smartSavings (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health My Choice Select (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health My Choice CalCare (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Honor+ Plan (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health ValorCare (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health L.A. Premium Giveback (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health S.D. Premium Giveback (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Platinum (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| Alignment Health NC Duals (HMO-POS D-SNP) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| Alignment Health Platinum + Instacart (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NV |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NV |
| Alignment Health Platinum Select (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| Alignment Health the ONE + Walgreens (HMO-POS) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $0 | TX |
| Alignment Health Heart & Diabetes (HMO-POS C-SNP) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $0 | TX |
| Alignment Health smartHMO (HMO-POS) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $0 | TX |
| Alignment Health Dual Select+ (HMO-POS D-SNP) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $0 | TX |
| Alignment Health Total Dual+ (HMO-POS D-SNP) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $0 | TX |
| Alignment Health smartSavings (HMO-POS) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $0 | TX |
| Alignment Health Advantage PPO (PPO) | ALIGNMENT HEALTH ADVANTAGE PLAN INC | T5 | Yes | $0 | CA |
| Alignment Health Heart & Diabetes (HMO C-SNP) | ALIGNMENT HEALTH PLAN OF NEVADA, INC. | T5 | Yes | $0 | NV |
| Alignment Health the ONE (HMO D-SNP) | ALIGNMENT HEALTH PLAN OF NEVADA, INC. | T5 | Yes | $0 | NV |
| Alignment Health Platinum + Instacart (HMO) | ALIGNMENT HEALTH PLAN OF NEVADA, INC. | T5 | Yes | $0 | NV |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN OF NEVADA, INC. | T5 | Yes | $0 | NV |
| Alignment Health + Intermountain Health (HMO) | ALIGNMENT HEALTH PLAN OF NEVADA, INC. | T5 | Yes | $0 | NV |
| Alignment Health Heart & Diabetes Choice (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0.70 | CA |
| Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $4.80 | TX |
| Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) | ALIGNMENT HEALTH PLAN OF NEVADA, INC. | T5 | Yes | $9.50 | NV |
| Alignment Health AVA (PPO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $10.00 | NC |
Frequently Asked Questions
Is 12 HR tapentadol 200 MG Extended Release Oral Tablet [Nucynta] covered by Medicare Part D?
Yes, 12 HR tapentadol 200 MG Extended Release Oral Tablet [Nucynta] is covered by 67 Medicare Part D plans (1.3% of all Part D formularies).
What tier is 12 HR tapentadol 200 MG Extended Release Oral Tablet [Nucynta] on Medicare Part D plans?
12 HR tapentadol 200 MG Extended Release Oral Tablet [Nucynta] averages Tier 5 across Part D plans, ranging from Tier 5 to Tier 5.
Does 12 HR tapentadol 200 MG Extended Release Oral Tablet [Nucynta] require prior authorization?
100% of Part D formularies require prior authorization for 12 HR tapentadol 200 MG Extended Release Oral Tablet [Nucynta]. Step therapy: 0%. Quantity limits: 100%.
How much does Medicare spend on 12 HR tapentadol 200 MG Extended Release Oral Tablet [Nucynta]?
In 2023, total Medicare Part D spending on 12 HR tapentadol 200 MG Extended Release Oral Tablet [Nucynta] was $58,810,957, covering 10,048 beneficiaries. The average spend per beneficiary was $5,853.00.
Read our methodology - how this data is sourced, computed, and verified.