Medicare Part D coverage · amoxicillin · RxCUI 2262032
amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia]
Per the CMS 2026 Part D formulary file, amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia] is covered by 1,080 Medicare Part D plans (21.4% of enrollable products), averaging Tier 4, with prior authorization required on 0% of covering formularies.
- 21.4%
- Plan coverage
- 1,080
- Plans covering
- T4
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia]
Per the CMS 2026 Part D formulary file, amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia] (RxNorm concept RXCUI 2262032, generic name amoxicillin) appears on 14 distinct formulary files spanning 1,080 Medicare Part D plan offerings - 21.4% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 4 to Tier 4, with a cross-plan average of Tier 4.
Real-world access to amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 50% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 6,202,496 Part D beneficiaries filled amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia] 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 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia] today.
Coverage Details
- Formularies covering
- 14
- Plans covering
- 1,080
- Coverage rate
- 21.4%
- Tier range
- Tier 4, Non-Preferred
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 50% of formularies
2023 Medicare Spending
- Beneficiaries
- 6,202,496
- Total spending
- $34,395,187
- Avg per beneficiary
- $5.55
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia]
9 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | No | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia]
91 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| HealthSpring Preferred (HMO) | Bravo Health Pennsylvania, Inc. | T4 | No | $0 | AZ |
| HealthSpring Alliance (HMO) | Bravo Health Pennsylvania, Inc. | T4 | No | $0 | AZ |
| HealthSpring Preferred Savings (HMO) | Bravo Health Pennsylvania, Inc. | T4 | No | $0 | AZ |
| HealthSpring Preferred Full Savings (HMO) | Bravo Health Pennsylvania, Inc. | T4 | No | $0 | AZ |
| HealthSpring Preferred GA (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | GA |
| HealthSpring Preferred Savings (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | GA |
| HealthSpring Preferred Savings (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | GA |
| HealthSpring Preferred Savings (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | GA |
| HealthSpring Preferred Savings (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | MO |
| HealthSpring Preferred Savings (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | MO |
| HealthSpring Premier (HMO-POS) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | UT |
| HealthSpring Preferred (HMO) | Healthspring Healthcare OF Colorado, Inc. | T4 | No | $0 | NM |
| HealthSpring Preferred (HMO) | Healthspring Healthcare OF Colorado, Inc. | T4 | No | $0 | OH |
Show the next 30 plans
| HealthSpring Preferred (HMO) | Healthspring Healthcare OF Colorado, Inc. | T4 | No | $0 | KY, OH |
| HealthSpring Preferred Savings (HMO) | Healthspring Healthcare OF Colorado, Inc. | T4 | No | $0 | OH |
| HealthSpring Preferred Savings (HMO) | Healthspring Healthcare OF Colorado, Inc. | T4 | No | $0 | KY, OH |
| HealthSpring Preferred (HMO) | Healthspring Healthcare OF Colorado, Inc. | T4 | No | $0 | CO |
| HealthSpring Preferred (HMO) | Bravo Health Mid-atlantic, Inc. | T4 | No | $0 | DC, DE |
| HealthSpring Preferred PA (HMO) | Bravo Health Pennsylvania, Inc. | T4 | No | $0 | PA |
| HealthSpring Preferred (HMO) | Bravo Health Pennsylvania, Inc. | T4 | No | $0 | PA |
| HealthSpring Preferred (HMO) | Bravo Health Pennsylvania, Inc. | T4 | No | $0 | PA |
| HealthSpring Preferred (HMO) | Bravo Health Pennsylvania, Inc. | T4 | No | $0 | PA |
| HealthSpring Preferred (HMO) | Bravo Health Pennsylvania, Inc. | T4 | No | $0 | PA |
| HealthSpring Preferred (HMO) | Bravo Health Pennsylvania, Inc. | T4 | No | $0 | PA |
| HealthSpring Preferred Savings (HMO) | Bravo Health Pennsylvania, Inc. | T4 | No | $0 | PA |
| HealthSpring Preferred (HMO) | Bravo Health Pennsylvania, Inc. | T4 | No | $0 | NJ |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | MS |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | WA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | OR, WA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | TX |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | TN |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | AR |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | MS, TN |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | AR |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | AR |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | TX |
| HealthSpring Alliance (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | TX |
| HealthSpring Preferred Savings (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | GA, TN |
| HealthSpring Preferred Savings (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | OK |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | TX |
| HealthSpring Preferred Savings (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | TX |
| HealthSpring Premier (HMO-POS) | Healthspring Life & Health Insurance Company, Inc. | T4 | No | $0 | IL |
Showing top 50 of 91 plans.
Frequently Asked Questions
Is amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia] covered by Medicare Part D?
Yes, amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia] is covered by 1,080 Medicare Part D plans (21.4% of all Part D formularies).
What tier is amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia] on Medicare Part D plans?
amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia] averages Tier 4 across Part D plans, ranging from Tier 4 to Tier 4.
Does amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia] require prior authorization?
0% of Part D formularies require prior authorization for amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia]. Step therapy: 0%. Quantity limits: 50%.
How much does Medicare spend on amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia]?
In 2023, total Medicare Part D spending on amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia] 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.
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
- dihydroergotamine mesylate 0.5 MG/ACTUAT Metered Dose Nasal Spray T4
- 0.5 ML darbepoetin alfa 0.2 MG/ML Prefilled Syringe [Aranesp] T4
- timolol hemihydrate 5 MG/ML Ophthalmic Solution [Betimol] T4
- deflazacort 18 MG Oral Tablet [Jaythari] T4
- bepotastine besilate 15 MG/ML Ophthalmic Solution [Bepreve] T4
- loteprednol etabonate 5 MG/ML Ophthalmic Suspension [Lotemax] T4