Medicare Part D coverage · amitriptyline hydrochloride · RxCUI 856762
amitriptyline hydrochloride 100 MG Oral Tablet
Per the CMS 2026 Part D formulary file, amitriptyline hydrochloride 100 MG Oral Tablet is covered by 5,052 Medicare Part D plans (100% of enrollable products), averaging Tier 2.2, with prior authorization required on 30.8% of covering formularies.
- 100%
- Plan coverage
- 5,052
- Plans covering
- T2.2
- Avg tier
- 30.8%
- Prior auth required
What the CMS Formulary Data Shows for amitriptyline hydrochloride 100 MG Oral Tablet
Per the CMS 2026 Part D formulary file, amitriptyline hydrochloride 100 MG Oral Tablet (RxNorm concept RXCUI 856762, generic name amitriptyline hydrochloride) appears on 328 distinct formulary files spanning 5,052 Medicare Part D plan offerings - 100% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.2.
Real-world access to amitriptyline hydrochloride 100 MG Oral Tablet depends on utilization management as much as tier placement: 30.8% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 838,449 Part D beneficiaries filled amitriptyline hydrochloride 100 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $73,881,287 and an average per-beneficiary annual cost of $88.12. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry amitriptyline hydrochloride 100 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 328
- Plans covering
- 5,052
- Coverage rate
- 100%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 30.8% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 838,449
- Total spending
- $73,881,287
- Avg per beneficiary
- $88.12
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering amitriptyline hydrochloride 100 MG Oral Tablet
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun MediMax (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun MediSun Plus (HMO D-SNP) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun MediSun Extra (HMO D-SNP) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun MediSun Full Dual Plus (HMO D-SNP) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun MediSun Full Dual Extra (HMO D-SNP) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
Show the next 30 plans
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Extra (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply More Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Complete Platinum (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply More Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Complete Platinum (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is amitriptyline hydrochloride 100 MG Oral Tablet covered by Medicare Part D?
Yes, amitriptyline hydrochloride 100 MG Oral Tablet is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).
What tier is amitriptyline hydrochloride 100 MG Oral Tablet on Medicare Part D plans?
amitriptyline hydrochloride 100 MG Oral Tablet averages Tier 2.2 across Part D plans, ranging from Tier 1 to Tier 4.
Does amitriptyline hydrochloride 100 MG Oral Tablet require prior authorization?
30.8% of Part D formularies require prior authorization for amitriptyline hydrochloride 100 MG Oral Tablet. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on amitriptyline hydrochloride 100 MG Oral Tablet?
In 2023, total Medicare Part D spending on amitriptyline hydrochloride 100 MG Oral Tablet was $73,881,287, covering 838,449 beneficiaries. The average spend per beneficiary was $88.12.
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
- 0.5 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] T2.2
- 1 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] T2.2
- glycopyrrolate 2 MG Oral Tablet T2.2
- ivermectin 3 MG Oral Tablet T2.2
- nitrofurantoin, macrocrystals 25 MG / nitrofurantoin, monohydrate 75 MG Oral Capsule T2.2
- Vibrio cholerae CVD 103-HGR strain live antigen 12000000 UNT/ML Oral Suspension [Vaxchora] T2.2
Similar prior-authorization rate
- 24 HR lacosamide 200 MG Extended Release Oral Capsule [Motpoly] 30.8% PA
- 72 HR scopolamine 0.0139 MG/HR Transdermal System 30.8% PA
- 24 HR lacosamide 100 MG Extended Release Oral Capsule [Motpoly] 30.8% PA
- 24 HR quetiapine 50 MG Extended Release Oral Tablet 31% PA
- 5 ML hydromorphone hydrochloride 10 MG/ML Injection 30.5% PA
- 24 HR quetiapine 400 MG Extended Release Oral Tablet 31.1% PA