24 HR levetiracetam 750 MG Extended Release Oral Tablet
levetiracetam
RxCUI: 846378
What the CMS Formulary Data Shows for 24 HR levetiracetam 750 MG Extended Release Oral Tablet
Per the CMS 2026 Part D formulary file, 24 HR levetiracetam 750 MG Extended Release Oral Tablet (RxNorm concept RXCUI 846378, generic name levetiracetam) appears on 315 distinct formulary files spanning 4,977 Medicare Part D plan offerings - 98.2% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.2.
Real-world access to 24 HR levetiracetam 750 MG Extended Release Oral Tablet depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 17.8% apply quantity limits.
Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 24 HR levetiracetam 750 MG Extended Release Oral Tablet today.
Coverage Details
- Formularies covering
- 315
- Plans covering
- 4,977
- Coverage rate
- 98.2%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 17.8% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 24 HR levetiracetam 750 MG Extended Release Oral Tablet
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | SENTARA HEALTH PLANS | T1 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | SENTARA HEALTH PLANS | T1 | No | $0 | VA |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | HPMP OF FLORIDA, INC. | T1 | No | $0 | FL |
| ElderServe MAP (HMO D-SNP) | ELDERSERVE HEALTH, INC. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | GROUP HEALTH COOPERATIVE OF EAU CLAIRE | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP | T1 | No | $0 | NJ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | ELDERPLAN, INC. | T1 | No | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | HEALTH CHOICE ARIZONA, INC. | T1 | No | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | HEALTHFIRST HEALTH PLAN, INC. | T1 | No | $0 | NY |
| IMCare Classic (HMO D-SNP) | ITASCA MEDICAL CARE | T1 | No | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | HOPKINS HEALTH ADVANTAGE, INC. | T1 | No | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | METROPLUS HEALTH PLAN, INC. | T1 | No | $0 | NY |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | UPPER PENINSULA HEALTH PLAN, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | CARESOURCE GEORGIA CO. | T1 | No | $0 | GA |
| Senior Whole Health SCO (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| Molina One Care (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP CARESOURCE | T1 | No | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | PRUITTHEALTH PREMIER, INC. | T1 | No | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | SIMPRA ADVANTAGE, INC. | T1 | No | $0 | AL |
| CareAdvantage (HMO D-SNP) | SAN MATEO HEALTH COMMISSION | T1 | No | $0 | CA |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | No | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | HORIZON HEALTHCARE OF NEW JERSEY, INC. | T1 | No | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | No | $0 | MN |
| NaviCare (HMO D-SNP) | FALLON COMMUNITY HEALTH PLAN | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| 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 |
| Troy Medicare (HMO) | TROY HEALTH, INC. | T1 | No | $0 | NC |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | TROY HEALTH, INC. | T1 | No | $0 | NC |
| Contra Costa Health Care Plus (HMO D-SNP) | CONTRA COSTA COUNTY MEDICAL SERVICE DBA CONTRA COSTA HEALTH | T1 | No | $0 | CA |
| Keystone First VIP Choice (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T1 | No | $0 | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T1 | No | $0 | PA |
| First Choice VIP Care (HMO D-SNP) | SELECT HEALTH OF SOUTH CAROLINA, INC. | T1 | No | $0 | SC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T1 | No | $0 | DE |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T1 | No | $0 | DE |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS FLORIDA INC | T1 | No | $0 | FL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS LOUISIANA, INC. | T1 | No | $0 | LA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS NORTH CAROLINA, INC. | T1 | No | $0 | NC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH MICHIGAN, INC. | T1 | No | $0 | MI |
| PHP (HMO C-SNP) | AIDS HEALTHCARE FOUNDATION | T1 | No | $0 | CA |
| CCA One Care (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | T1 | No | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | T1 | No | $0 | MA |
| Elevate Medicare Choice (HMO D-SNP) | DENVER HEALTH MEDICAL PLAN, INC. | T1 | No | $0 | CO |
Frequently Asked Questions
Is 24 HR levetiracetam 750 MG Extended Release Oral Tablet covered by Medicare Part D?
Yes, 24 HR levetiracetam 750 MG Extended Release Oral Tablet is covered by 4,977 Medicare Part D plans (98.2% of all Part D formularies).
What tier is 24 HR levetiracetam 750 MG Extended Release Oral Tablet on Medicare Part D plans?
24 HR levetiracetam 750 MG Extended Release Oral Tablet averages Tier 2.2 across Part D plans, ranging from Tier 1 to Tier 4.
Does 24 HR levetiracetam 750 MG Extended Release Oral Tablet require prior authorization?
0% of Part D formularies require prior authorization for 24 HR levetiracetam 750 MG Extended Release Oral Tablet. Step therapy: 0%. Quantity limits: 17.8%.
Read our methodology - how this data is sourced, computed, and verified.