Medicare Part D coverage · alogliptin · RxCUI 1368392
alogliptin 12.5 MG / metformin hydrochloride 500 MG Oral Tablet
Per the CMS 2026 Part D formulary file, alogliptin 12.5 MG / metformin hydrochloride 500 MG Oral Tablet is covered by 76 Medicare Part D plans (1.5% of enrollable products), averaging Tier 1.8, with prior authorization required on 8.3% of covering formularies.
- 1.5%
- Plan coverage
- 76
- Plans covering
- T1.8
- Avg tier
- 8.3%
- Prior auth required
What the CMS Formulary Data Shows for alogliptin 12.5 MG / metformin hydrochloride 500 MG Oral Tablet
Per the CMS 2026 Part D formulary file, alogliptin 12.5 MG / metformin hydrochloride 500 MG Oral Tablet (RxNorm concept RXCUI 1368392, generic name alogliptin) appears on 12 distinct formulary files spanning 76 Medicare Part D plan offerings - 1.5% 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 1.8.
Real-world access to alogliptin 12.5 MG / metformin hydrochloride 500 MG Oral Tablet depends on utilization management as much as tier placement: 8.3% of covering formularies require prior authorization. 0% require step therapy. 75% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 17,642 Part D beneficiaries filled alogliptin 12.5 MG / metformin hydrochloride 500 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $14,741,684 and an average per-beneficiary annual cost of $835.60. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry alogliptin 12.5 MG / metformin hydrochloride 500 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 12
- Plans covering
- 76
- Coverage rate
- 1.5%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 8.3% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 75% of formularies
2023 Medicare Spending
- Beneficiaries
- 17,642
- Total spending
- $14,741,684
- Avg per beneficiary
- $835.60
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering alogliptin 12.5 MG / metformin hydrochloride 500 MG Oral Tablet
76 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T1 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T1 | No | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | Selecthealth, Inc. | T1 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T1 | No | $0 | UT |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T1 | No | $0 | NV |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T1 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T1 | No | $0 | CO |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T1 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T1 | No | $0 | CO |
| Select Health Medicare Flex (HMO) | Selecthealth, Inc. | T1 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T1 | No | $0 | CO |
| Select Health Medicare Active (HMO) | Selecthealth, Inc. | T1 | No | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | Selecthealth, Inc. | T1 | No | $0 | NV |
| Select Health Medicare Wellness (HMO) | Selecthealth, Inc. | T1 | No | $0 | NV |
| Personal Choice 65 Achieve Rx (PPO) | QCC Insurance Company | T1 | No | $0 | PA |
| Keystone 65 Focus Rx (HMO-POS) | Keystone Health Plan East, Inc. | T1 | No | $0 | PA |
| Keystone 65 Focus Rx (HMO-POS) | Keystone Health Plan East, Inc. | T1 | No | $0 | PA |
| Keystone 65 Basic Rx (HMO) | Keystone Health Plan East, Inc. | T1 | No | $0 | PA |
| AmeriHealth Medicare Core (PPO) | Amerihealth Insurance Company OF NEW Jersey | T1 | No | $0 | NJ |
| AmeriHealth Medicare Ultimate (PPO) | Amerihealth Insurance Company OF NEW Jersey | T1 | No | $0 | NJ |
Show the next 30 plans
| Healthy Mississippi Premier Advantage (HMO-POS) | Healthy Mississippi, Inc. | T1 | No | $0 | MS |
| MMM Supremo (HMO C-SNP) | MMM Healthcare, LLC | T1 | No | $0 | PR |
| MMM Diamante Platino (HMO D-SNP) | MMM Healthcare, LLC | T1 | No | $0 | PR |
| MMM Unico (HMO-POS) | MMM Healthcare, LLC | T1 | No | $0 | PR |
| MMM Elite (HMO-POS) | MMM Healthcare, LLC | T1 | No | $0 | PR |
| MMM Deluxe (HMO-POS) | MMM Healthcare, LLC | T1 | No | $0 | PR |
| MMM Dorado Platino (HMO D-SNP) | MMM Healthcare, LLC | T1 | No | $0 | PR |
| PMC Premier Platino (HMO D-SNP) | MMM Healthcare, LLC | T1 | No | $0 | PR |
| PMC Max (HMO-POS) | MMM Healthcare, LLC | T1 | No | $0 | PR |
| MMM Plenitud (HMO-POS) | MMM Healthcare, LLC | T1 | No | $0 | PR |
| MMM Valioso (HMO-POS) | MMM Healthcare, LLC | T1 | No | $0 | PR |
| MMM Combo Platino (HMO D-SNP) | MMM Healthcare, LLC | T1 | No | $0 | PR |
| MMM Flexi Platino (HMO D-SNP) | MMM Healthcare, LLC | T1 | No | $0 | PR |
| MMM Grandioso (HMO-POS) | MMM Healthcare, LLC | T1 | No | $0 | PR |
| MMM Mega Flex (HMO-POS) | MMM Healthcare, LLC | T1 | No | $0 | PR |
| MMM Relax Platino (HMO D-SNP) | MMM Healthcare, LLC | T1 | No | $0 | PR |
| MMM Balance (HMO-POS) | MMM Healthcare, LLC | T1 | No | $0 | PR |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | No | $0 | CA |
| Leon MediExtra (HMO) | Leon Health, Inc. | T1 | No | $0 | FL |
| Leon MediDual (HMO D-SNP) | Leon Health, Inc. | T1 | No | $0 | FL |
| Leon MediMore (HMO) | Leon Health, Inc. | T1 | No | $0 | FL |
| Leon MediMax (HMO D-SNP) | Leon Health, Inc. | T1 | No | $0 | FL |
| Keystone 65 Essential Rx (HMO-POS) | Keystone Health Plan East, Inc. | T1 | No | $31.00 | PA |
| AmeriHealth Medicare Enhanced (PPO) | Amerihealth Insurance Company OF NEW Jersey | T1 | No | $36.00 | NJ |
| Keystone 65 Select Rx (HMO) | Keystone Health Plan East, Inc. | T1 | No | $47.00 | PA |
| Keystone 65 Preferred Rx (HMO) | Keystone Health Plan East, Inc. | T1 | No | $59.70 | PA |
| Keystone 65 Select Rx (HMO) | Keystone Health Plan East, Inc. | T1 | No | $63.50 | PA |
| Keystone 65 Preferred Rx (HMO) | Keystone Health Plan East, Inc. | T1 | No | $79.70 | PA |
| Personal Choice 65 Plus Rx (PPO) | QCC Insurance Company | T1 | No | $81.20 | PA |
Showing top 50 of 76 plans.
Frequently Asked Questions
Is alogliptin 12.5 MG / metformin hydrochloride 500 MG Oral Tablet covered by Medicare Part D?
Yes, alogliptin 12.5 MG / metformin hydrochloride 500 MG Oral Tablet is covered by 76 Medicare Part D plans (1.5% of all Part D formularies).
What tier is alogliptin 12.5 MG / metformin hydrochloride 500 MG Oral Tablet on Medicare Part D plans?
alogliptin 12.5 MG / metformin hydrochloride 500 MG Oral Tablet averages Tier 1.8 across Part D plans, ranging from Tier 1 to Tier 4.
Does alogliptin 12.5 MG / metformin hydrochloride 500 MG Oral Tablet require prior authorization?
8.3% of Part D formularies require prior authorization for alogliptin 12.5 MG / metformin hydrochloride 500 MG Oral Tablet. Step therapy: 0%. Quantity limits: 75%.
How much does Medicare spend on alogliptin 12.5 MG / metformin hydrochloride 500 MG Oral Tablet?
In 2023, total Medicare Part D spending on alogliptin 12.5 MG / metformin hydrochloride 500 MG Oral Tablet was $14,741,684, covering 17,642 beneficiaries. The average spend per beneficiary was $835.60.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
Similar prior-authorization rate
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