{56 (amoxicillin 500 MG Oral Capsule) / 28 (clarithromycin 500 MG Oral Tablet) / 28 (vonoprazan 20 MG Oral Tablet) } Pack [Voquezna 14 Day TriplePak 20;500;500]
amoxicillin
RxCUI: 2604804
What the CMS Formulary Data Shows for {56 (amoxicillin 500 MG Oral Capsule) / 28 (clarithromycin 500 MG Oral Tablet) / 28 (vonoprazan 20 MG Oral Tablet) } Pack [Voquezna 14 Day TriplePak 20;500;500]
Per the CMS 2026 Part D formulary file, {56 (amoxicillin 500 MG Oral Capsule) / 28 (clarithromycin 500 MG Oral Tablet) / 28 (vonoprazan 20 MG Oral Tablet) } Pack [Voquezna 14 Day TriplePak 20;500;500] (RxNorm concept RXCUI 2604804, generic name amoxicillin) appears on 111 distinct formulary files spanning 2,307 Medicare Part D plan offerings - 45.5% 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 3.2.
Real-world access to {56 (amoxicillin 500 MG Oral Capsule) / 28 (clarithromycin 500 MG Oral Tablet) / 28 (vonoprazan 20 MG Oral Tablet) } Pack [Voquezna 14 Day TriplePak 20;500;500] depends on utilization management as much as tier placement: 91.9% of covering formularies require prior authorization. 0% require step therapy. 71.2% 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 {56 (amoxicillin 500 MG Oral Capsule) / 28 (clarithromycin 500 MG Oral Tablet) / 28 (vonoprazan 20 MG Oral Tablet) } Pack [Voquezna 14 Day TriplePak 20;500;500] today.
Coverage Details
- Formularies covering
- 111
- Plans covering
- 2,307
- Coverage rate
- 45.5%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 91.9% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 71.2% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering {56 (amoxicillin 500 MG Oral Capsule) / 28 (clarithromycin 500 MG Oral Tablet) / 28 (vonoprazan 20 MG Oral Tablet) } Pack [Voquezna 14 Day TriplePak 20;500;500]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | HPMP OF FLORIDA, INC. | T1 | Yes | $0 | FL |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | ELDERPLAN, INC. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | HEALTH CHOICE ARIZONA, INC. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | HEALTHFIRST HEALTH PLAN, INC. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | ITASCA MEDICAL CARE | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | HOPKINS HEALTH ADVANTAGE, INC. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | METROPLUS HEALTH PLAN, INC. | T1 | Yes | $0 | NY |
| Senior Whole Health SCO (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | Yes | $0 | MA |
| NaviCare (HMO D-SNP) | FALLON COMMUNITY HEALTH PLAN | T1 | Yes | $0 | MA |
| 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 |
| CCA One Care (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | T1 | Yes | $0 | MA |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | Yes | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | Yes | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | Yes | $0 | IN |
| Provider Partners Maryland Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | Yes | $0 | MD |
| Provider Partners Missouri Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | Yes | $0 | MO |
| Tufts Health One Care (HMO D-SNP) | TUFTS HEALTH PUBLIC PLANS, INC. | T1 | Yes | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | TUFTS HEALTH PUBLIC PLANS, INC. | T1 | Yes | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION | T1 | Yes | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION | T1 | Yes | $0 | MA |
| Florida Complete Care (HMO I-SNP) | HPMP OF FLORIDA, INC. | T1 | Yes | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | HPMP OF FLORIDA, INC. | T1 | Yes | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC. | T1 | Yes | $4.80 | TX |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS | T1 | Yes | $15.20 | IL |
| Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) | ELDERPLAN, INC. | T1 | Yes | $22.70 | NY |
| VIVA Medicare Extra Value (HMO D-SNP) | VIVA HEALTH, INC. | T1 | Yes | $27.70 | AL |
| VIVA Medicare Extra Care (HMO D-SNP) | VIVA HEALTH, INC. | T1 | Yes | $27.70 | AL |
| Provider Partners Maryland Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | Yes | $31.20 | MD |
| Provider Partners Maryland Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | Yes | $31.20 | MD |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | Yes | $32.70 | PA |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | Yes | $32.70 | PA |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | Yes | $36.20 | NC |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | Yes | $36.20 | NC |
| Provider Partners Indiana Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | Yes | $38.40 | IN |
| Provider Partners Indiana Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | Yes | $38.40 | IN |
| Provider Partners Kentucky Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF KENTUCKY | T1 | Yes | $38.40 | KY |
| Provider Partners Missouri Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | Yes | $43.00 | MO |
| Provider Partners Missouri Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | Yes | $43.00 | MO |
| Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) | ELDERPLAN, INC. | T1 | Yes | $44.80 | NY |
| MetroPlus Platinum Plan (HMO) | METROPLUS HEALTH PLAN, INC. | T1 | Yes | $58.80 | NY |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| Sharp Direct Advantage Gold (HMO) | SHARP HEALTH PLAN | T3 | Yes | $0 | CA |
Frequently Asked Questions
Is {56 (amoxicillin 500 MG Oral Capsule) / 28 (clarithromycin 500 MG Oral Tablet) / 28 (vonoprazan 20 MG Oral Tablet) } Pack [Voquezna 14 Day TriplePak 20;500;500] covered by Medicare Part D?
Yes, {56 (amoxicillin 500 MG Oral Capsule) / 28 (clarithromycin 500 MG Oral Tablet) / 28 (vonoprazan 20 MG Oral Tablet) } Pack [Voquezna 14 Day TriplePak 20;500;500] is covered by 2,307 Medicare Part D plans (45.5% of all Part D formularies).
What tier is {56 (amoxicillin 500 MG Oral Capsule) / 28 (clarithromycin 500 MG Oral Tablet) / 28 (vonoprazan 20 MG Oral Tablet) } Pack [Voquezna 14 Day TriplePak 20;500;500] on Medicare Part D plans?
{56 (amoxicillin 500 MG Oral Capsule) / 28 (clarithromycin 500 MG Oral Tablet) / 28 (vonoprazan 20 MG Oral Tablet) } Pack [Voquezna 14 Day TriplePak 20;500;500] averages Tier 3.2 across Part D plans, ranging from Tier 1 to Tier 4.
Does {56 (amoxicillin 500 MG Oral Capsule) / 28 (clarithromycin 500 MG Oral Tablet) / 28 (vonoprazan 20 MG Oral Tablet) } Pack [Voquezna 14 Day TriplePak 20;500;500] require prior authorization?
91.9% of Part D formularies require prior authorization for {56 (amoxicillin 500 MG Oral Capsule) / 28 (clarithromycin 500 MG Oral Tablet) / 28 (vonoprazan 20 MG Oral Tablet) } Pack [Voquezna 14 Day TriplePak 20;500;500]. Step therapy: 0%. Quantity limits: 71.2%.
Read our methodology - how this data is sourced, computed, and verified.