24 HR amantadine 68.5 MG Extended Release Oral Capsule [Gocovri]
amantadine
RxCUI: 1944382
What the CMS Formulary Data Shows for 24 HR amantadine 68.5 MG Extended Release Oral Capsule [Gocovri]
Per the CMS 2026 Part D formulary file, 24 HR amantadine 68.5 MG Extended Release Oral Capsule [Gocovri] (RxNorm concept RXCUI 1944382, generic name amantadine) appears on 17 distinct formulary files spanning 112 Medicare Part D plan offerings - 2.2% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.3.
Real-world access to 24 HR amantadine 68.5 MG Extended Release Oral Capsule [Gocovri] depends on utilization management as much as tier placement: 88.2% of covering formularies require prior authorization. 5.9% require step therapy. 64.7% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 4,464 Part D beneficiaries filled 24 HR amantadine 68.5 MG Extended Release Oral Capsule [Gocovri] in 2023, with total plan-and-beneficiary spending of $91,875,721 and an average per-beneficiary annual cost of $20,581.48. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 24 HR amantadine 68.5 MG Extended Release Oral Capsule [Gocovri] today.
Coverage Details
- Formularies covering
- 17
- Plans covering
- 112
- Coverage rate
- 2.2%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 88.2% of formularies
- Step therapy required
- 5.9% of formularies
- Quantity limits
- 64.7% of formularies
2023 Medicare Spending
- Beneficiaries
- 4,464
- Total spending
- $91,875,721
- Avg per beneficiary
- $20,581.48
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 24 HR amantadine 68.5 MG Extended Release Oral Capsule [Gocovri]
100 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 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | ALAMEDA ALLIANCE FOR HEALTH | T1 | Yes | $0 | CA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK HEALTH OPTIONS WEST VIRGINIA INC. | T1 | No | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | No | $0 | DE |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $13.10 | PA |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $17.60 | PA |
| Highmark Health Options Duals Select (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | No | $31.20 | DE |
| HealthSun HealthAdvantage Plan (HMO) | HEALTHSUN HEALTH PLANS, INC. | T5 | No | $0 | FL |
| HealthSun MediMax (HMO) | HEALTHSUN HEALTH PLANS, INC. | T5 | No | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | HEALTHSUN HEALTH PLANS, INC. | T5 | No | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | HEALTHSUN HEALTH PLANS, INC. | T5 | No | $0 | FL |
| HealthSun MediSun Plus (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T5 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | HEALTHSUN HEALTH PLANS, INC. | T5 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | HEALTHSUN HEALTH PLANS, INC. | T5 | No | $0 | FL |
| HealthSun MediSun Extra (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T5 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | HEALTHSUN HEALTH PLANS, INC. | T5 | No | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | HEALTHSUN HEALTH PLANS, INC. | T5 | No | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | HEALTHSUN HEALTH PLANS, INC. | T5 | No | $0 | FL |
| HealthSun MediSun Full Dual Plus (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T5 | No | $0 | FL |
| HealthSun MediSun Full Dual Extra (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T5 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Extra (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Extra Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply More Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Complete Platinum (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Extra Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Extra Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Extra Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply More Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
| Simply Complete Platinum (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T5 | No | $0 | FL |
Frequently Asked Questions
Is 24 HR amantadine 68.5 MG Extended Release Oral Capsule [Gocovri] covered by Medicare Part D?
Yes, 24 HR amantadine 68.5 MG Extended Release Oral Capsule [Gocovri] is covered by 112 Medicare Part D plans (2.2% of all Part D formularies).
What tier is 24 HR amantadine 68.5 MG Extended Release Oral Capsule [Gocovri] on Medicare Part D plans?
24 HR amantadine 68.5 MG Extended Release Oral Capsule [Gocovri] averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 5.
Does 24 HR amantadine 68.5 MG Extended Release Oral Capsule [Gocovri] require prior authorization?
88.2% of Part D formularies require prior authorization for 24 HR amantadine 68.5 MG Extended Release Oral Capsule [Gocovri]. Step therapy: 5.9%. Quantity limits: 64.7%.
How much does Medicare spend on 24 HR amantadine 68.5 MG Extended Release Oral Capsule [Gocovri]?
In 2023, total Medicare Part D spending on 24 HR amantadine 68.5 MG Extended Release Oral Capsule [Gocovri] was $91,875,721, covering 4,464 beneficiaries. The average spend per beneficiary was $20,581.48.
Read our methodology - how this data is sourced, computed, and verified.