acetaminophen 300 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule [Fioricet]
acetaminophen
RxCUI: 1432261
What the CMS Formulary Data Shows for acetaminophen 300 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule [Fioricet]
Per the CMS 2026 Part D formulary file, acetaminophen 300 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule [Fioricet] (RxNorm concept RXCUI 1432261, generic name acetaminophen) appears on 6 distinct formulary files spanning 22 Medicare Part D plan offerings - 0.4% 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 2.2.
Real-world access to acetaminophen 300 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule [Fioricet] depends on utilization management as much as tier placement: 50% 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 156 Part D beneficiaries filled acetaminophen 300 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule [Fioricet] 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 300 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule [Fioricet] today.
Coverage Details
- Formularies covering
- 6
- Plans covering
- 22
- Coverage rate
- 0.4%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 50% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 100% 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 300 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule [Fioricet]
22 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| PHP (HMO C-SNP) | AIDS HEALTHCARE FOUNDATION | T1 | Yes | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS CHOICE | T1 | No | $0 | NY |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T1 | No | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T1 | No | $17.00 | AZ |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS CHOICE | T1 | No | $51.60 | NY |
| Gold Heart & Diabetes (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T2 | No | $0 | FL |
| Gold Heart & Diabetes Complete (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T2 | No | $0 | FL |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T2 | No | $0 | FL |
| Gold Health (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T2 | No | $0 | FL |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T2 | No | $0 | FL |
| Gold Heart & Diabetes (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T2 | No | $0 | AZ |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T2 | No | $0 | AZ |
| Gold Heart & Diabetes (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T2 | No | $0 | AZ |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T2 | No | $0 | AZ |
| SummaCare Medicare Topaz (HMO) | SUMMACARE INC. | T4 | Yes | $0 | OH |
| SummaCare Medicare Quartz (HMO) | SUMMACARE INC. | T4 | Yes | $0 | OH |
| VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) | VILLAGE SENIOR SERVICES CORPORATION | T4 | Yes | $0 | NY |
| VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) | VILLAGE SENIOR SERVICES CORPORATION | T4 | Yes | $0 | NY |
| SummaCare Medicare Garnet (HMO) | SUMMACARE INC. | T4 | Yes | $35.00 | OH |
| SummaCare Medicare Ruby (HMO) | SUMMACARE INC. | T4 | Yes | $50.00 | OH |
| SummaCare Medicare Sapphire (HMO-POS) | SUMMACARE INC. | T4 | Yes | $83.00 | OH |
| SummaCare Medicare Emerald (HMO-POS) | SUMMACARE INC. | T4 | Yes | $100.80 | OH |
Frequently Asked Questions
Is acetaminophen 300 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule [Fioricet] covered by Medicare Part D?
Yes, acetaminophen 300 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule [Fioricet] is covered by 22 Medicare Part D plans (0.4% of all Part D formularies).
What tier is acetaminophen 300 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule [Fioricet] on Medicare Part D plans?
acetaminophen 300 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule [Fioricet] averages Tier 2.2 across Part D plans, ranging from Tier 1 to Tier 4.
Does acetaminophen 300 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule [Fioricet] require prior authorization?
50% of Part D formularies require prior authorization for acetaminophen 300 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule [Fioricet]. Step therapy: 0%. Quantity limits: 100%.
How much does Medicare spend on acetaminophen 300 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule [Fioricet]?
In 2023, total Medicare Part D spending on acetaminophen 300 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule [Fioricet] 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.