amoxicillin 25 MG/ML / clavulanate 6.25 MG/ML Oral Suspension [Augmentin]
amoxicillin
RxCUI: 617333
What the CMS Formulary Data Shows for amoxicillin 25 MG/ML / clavulanate 6.25 MG/ML Oral Suspension [Augmentin]
Per the CMS 2026 Part D formulary file, amoxicillin 25 MG/ML / clavulanate 6.25 MG/ML Oral Suspension [Augmentin] (RxNorm concept RXCUI 617333, generic name amoxicillin) appears on 48 distinct formulary files spanning 502 Medicare Part D plan offerings - 9.9% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 3.5.
Real-world access to amoxicillin 25 MG/ML / clavulanate 6.25 MG/ML Oral Suspension [Augmentin] depends on utilization management as much as tier placement: 0% 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 6,202,496 Part D beneficiaries filled amoxicillin 25 MG/ML / clavulanate 6.25 MG/ML Oral Suspension [Augmentin] in 2023, with total plan-and-beneficiary spending of $34,395,187 and an average per-beneficiary annual cost of $5.55. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry amoxicillin 25 MG/ML / clavulanate 6.25 MG/ML Oral Suspension [Augmentin] today.
Coverage Details
- Formularies covering
- 48
- Plans covering
- 502
- Coverage rate
- 9.9%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 6,202,496
- Total spending
- $34,395,187
- Avg per beneficiary
- $5.55
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering amoxicillin 25 MG/ML / clavulanate 6.25 MG/ML Oral Suspension [Augmentin]
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 |
| 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 |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $0 | IN |
| Provider Partners Maryland Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $0 | MD |
| Provider Partners Missouri Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $0 | MO |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF FLORIDA, INC. | T1 | No | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC. | T1 | No | $4.80 | TX |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF MICHIGAN, INC. | T1 | No | $8.80 | MI |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF ILLINOIS, INC. | T1 | No | $15.20 | IL |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS | T1 | No | $15.20 | IL |
| WellSense Added Value (HMO) | BOSTON MEDICAL CENTER HEALTH PLAN, INC. | T1 | No | $21.70 | NH |
| Provider Partners Maryland Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $31.20 | MD |
| Provider Partners Maryland Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $31.20 | MD |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $32.70 | PA |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $32.70 | PA |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF COLORADO, INC. | T1 | No | $35.20 | CO |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC. | T1 | No | $36.20 | NC |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $36.20 | NC |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $36.20 | NC |
| Provider Partners Indiana Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $38.40 | IN |
| Provider Partners Indiana Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $38.40 | IN |
| Provider Partners Kentucky Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF KENTUCKY | T1 | No | $38.40 | KY |
| Longevity Health Plan (PPO I-SNP) | LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP | T1 | No | $40.00 | NJ |
| Provider Partners Missouri Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $43.00 | MO |
| Provider Partners Missouri Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $43.00 | MO |
| 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 |
| Health New England Medicare Compass (PPO) | HEALTH NEW ENGLAND, INC. | T2 | No | $0 | MA |
| Health New England Medicare Value (HMO) | HEALTH NEW ENGLAND, INC. | T2 | No | $0 | MA |
| Health New England Medicare Premium (HMO) | HEALTH NEW ENGLAND, INC. | T2 | No | $15.80 | MA |
| Health New England Medicare Plus (HMO) | HEALTH NEW ENGLAND, INC. | T2 | No | $58.40 | MA |
| Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Enhanced Solano (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Inland Empire (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Ventura (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Enhanced Kern (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Basic Kern (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Senior Advantage San Diego (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Basic Stanis (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
Frequently Asked Questions
Is amoxicillin 25 MG/ML / clavulanate 6.25 MG/ML Oral Suspension [Augmentin] covered by Medicare Part D?
Yes, amoxicillin 25 MG/ML / clavulanate 6.25 MG/ML Oral Suspension [Augmentin] is covered by 502 Medicare Part D plans (9.9% of all Part D formularies).
What tier is amoxicillin 25 MG/ML / clavulanate 6.25 MG/ML Oral Suspension [Augmentin] on Medicare Part D plans?
amoxicillin 25 MG/ML / clavulanate 6.25 MG/ML Oral Suspension [Augmentin] averages Tier 3.5 across Part D plans, ranging from Tier 1 to Tier 5.
Does amoxicillin 25 MG/ML / clavulanate 6.25 MG/ML Oral Suspension [Augmentin] require prior authorization?
0% of Part D formularies require prior authorization for amoxicillin 25 MG/ML / clavulanate 6.25 MG/ML Oral Suspension [Augmentin]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on amoxicillin 25 MG/ML / clavulanate 6.25 MG/ML Oral Suspension [Augmentin]?
In 2023, total Medicare Part D spending on amoxicillin 25 MG/ML / clavulanate 6.25 MG/ML Oral Suspension [Augmentin] was $34,395,187, covering 6,202,496 beneficiaries. The average spend per beneficiary was $5.55.
Read our methodology - how this data is sourced, computed, and verified.