acetaminophen 21.7 MG/ML / hydrocodone bitartrate 0.67 MG/ML Oral Solution
acetaminophen
RxCUI: 856944
What the CMS Formulary Data Shows for acetaminophen 21.7 MG/ML / hydrocodone bitartrate 0.67 MG/ML Oral Solution
Per the CMS 2026 Part D formulary file, acetaminophen 21.7 MG/ML / hydrocodone bitartrate 0.67 MG/ML Oral Solution (RxNorm concept RXCUI 856944, generic name acetaminophen) appears on 117 distinct formulary files spanning 3,238 Medicare Part D plan offerings - 63.9% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.6.
Real-world access to acetaminophen 21.7 MG/ML / hydrocodone bitartrate 0.67 MG/ML Oral Solution depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 93.2% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 156 Part D beneficiaries filled acetaminophen 21.7 MG/ML / hydrocodone bitartrate 0.67 MG/ML Oral Solution in 2023, with total plan-and-beneficiary spending of $48,943 and an average per-beneficiary annual cost of $313.74. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry acetaminophen 21.7 MG/ML / hydrocodone bitartrate 0.67 MG/ML Oral Solution today.
Coverage Details
- Formularies covering
- 117
- Plans covering
- 3,238
- Coverage rate
- 63.9%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 93.2% of formularies
2023 Medicare Spending
- Beneficiaries
- 156
- Total spending
- $48,943
- Avg per beneficiary
- $313.74
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering acetaminophen 21.7 MG/ML / hydrocodone bitartrate 0.67 MG/ML Oral Solution
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| 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 |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP CARESOURCE | T1 | No | $0 | MI |
| CareAdvantage (HMO D-SNP) | SAN MATEO HEALTH COMMISSION | T1 | No | $0 | CA |
| NaviCare (HMO D-SNP) | FALLON COMMUNITY HEALTH PLAN | T1 | No | $0 | MA |
| PHP (HMO C-SNP) | AIDS HEALTHCARE FOUNDATION | T1 | No | $0 | CA |
| Elevate Medicare Choice (HMO D-SNP) | DENVER HEALTH MEDICAL PLAN, INC. | T1 | No | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | ALLCARE HEALTH PLAN, INC. | T1 | No | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE | T1 | No | $0 | MN |
| Prime Health Complete (HMO D-SNP) | PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE | T1 | No | $0 | MN |
| DualConnect (HMO D-SNP) | SANTA CLARA COUNTY HEALTH AUTHORITY | T1 | No | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS CHOICE | T1 | No | $0 | NY |
| Alterwood Advantage Dual Secure (HMO D-SNP) | ALTERWOOD ADVANTAGE, INC. | T1 | No | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK | T1 | No | $0 | NY |
| Abilis Health Community (HMO I-SNP) | SIGNATURE ADVANTAGE, LLC | T1 | No | $0 | KY, TN |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T1 | No | $0 | CA |
| Mass General Brigham SCO (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | No | $0 | MA |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF FLORIDA, INC. | T1 | No | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T1 | No | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | TEXAS INDEPENDENCE HEALTH PLAN, INC. | T1 | No | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | TEXAS INDEPENDENCE HEALTH PLAN, INC. | T1 | No | $4.80 | TX |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF MICHIGAN, INC. | T1 | No | $8.80 | MI |
| ATRIO Special Needs Plan (HMO D-SNP) | ATRIO HEALTH PLANS | T1 | No | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | ATRIO HEALTH PLANS | T1 | No | $10.50 | OR |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF ILLINOIS, INC. | T1 | No | $15.20 | IL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T1 | No | $17.00 | AZ |
| WellSense Added Value (HMO) | BOSTON MEDICAL CENTER HEALTH PLAN, INC. | T1 | No | $21.70 | NH |
| Alterwood Advantage Dual Value (HMO D-SNP) | ALTERWOOD ADVANTAGE, INC. | T1 | No | $31.20 | MD |
| Valor Health Plan (HMO I-SNP) | TSG GUARD, INC. | T1 | No | $31.40 | OH |
| WV Senior Advantage (HMO I-SNP) | WEST VIRGINIA SENIOR ADVANTAGE, INC. | T1 | No | $32.70 | WV |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF COLORADO, INC. | T1 | No | $35.20 | CO |
| Abilis Health (HMO I-SNP) | SIGNATURE ADVANTAGE, LLC | T1 | No | $35.90 | KY, TN |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC. | T1 | No | $36.20 | NC |
| CommuniCare Advantage ISNP (HMO I-SNP) | OH CHS SNP INC. | T1 | No | $38.40 | IN, MD, OH |
| Longevity Health Plan (PPO I-SNP) | LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP | T1 | No | $40.00 | NJ |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS CHOICE | T1 | No | $51.60 | NY |
| ElderServe Star (HMO I-SNP) | ELDERSERVE HEALTH, INC. | T1 | No | $58.80 | NY |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF NEW YORK, INC. | T1 | No | $58.80 | NY |
| Nascentia Skilled Nursing Facility (HMO I-SNP) | VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK | T1 | No | $58.80 | NY |
| MCS Classicare RxMax (HMO) | MCS ADVANTAGE, INC. | T2 | No | $0 | PR |
| MCS Classicare Platino Ideal (HMO D-SNP) | MCS ADVANTAGE, INC. | T2 | No | $0 | PR |
| MCS Classicare Efectivo (HMO) | MCS ADVANTAGE, INC. | T2 | No | $0 | PR |
| MCS Classicare Essential (HMO-POS) | MCS ADVANTAGE, INC. | T2 | No | $0 | PR |
| MCS Classicare Platino Progreso (HMO D-SNP) | MCS ADVANTAGE, INC. | T2 | No | $0 | PR |
| MCS Classicare Primero (HMO C-SNP) | MCS ADVANTAGE, INC. | T2 | No | $0 | PR |
| MCS Classicare Firme (HMO) | MCS ADVANTAGE, INC. | T2 | No | $0 | PR |
Frequently Asked Questions
Is acetaminophen 21.7 MG/ML / hydrocodone bitartrate 0.67 MG/ML Oral Solution covered by Medicare Part D?
Yes, acetaminophen 21.7 MG/ML / hydrocodone bitartrate 0.67 MG/ML Oral Solution is covered by 3,238 Medicare Part D plans (63.9% of all Part D formularies).
What tier is acetaminophen 21.7 MG/ML / hydrocodone bitartrate 0.67 MG/ML Oral Solution on Medicare Part D plans?
acetaminophen 21.7 MG/ML / hydrocodone bitartrate 0.67 MG/ML Oral Solution averages Tier 2.6 across Part D plans, ranging from Tier 1 to Tier 4.
Does acetaminophen 21.7 MG/ML / hydrocodone bitartrate 0.67 MG/ML Oral Solution require prior authorization?
0% of Part D formularies require prior authorization for acetaminophen 21.7 MG/ML / hydrocodone bitartrate 0.67 MG/ML Oral Solution. Step therapy: 0%. Quantity limits: 93.2%.
How much does Medicare spend on acetaminophen 21.7 MG/ML / hydrocodone bitartrate 0.67 MG/ML Oral Solution?
In 2023, total Medicare Part D spending on acetaminophen 21.7 MG/ML / hydrocodone bitartrate 0.67 MG/ML Oral Solution was $48,943, covering 156 beneficiaries. The average spend per beneficiary was $313.74.
Read our methodology - how this data is sourced, computed, and verified.