amphetamine sulfate 5 MG Oral Tablet
amphetamine sulfate
RxCUI: 884655
What the CMS Formulary Data Shows for amphetamine sulfate 5 MG Oral Tablet
Per the CMS 2026 Part D formulary file, amphetamine sulfate 5 MG Oral Tablet (RxNorm concept RXCUI 884655, generic name amphetamine sulfate) appears on 4 distinct formulary files spanning 29 Medicare Part D plan offerings - 0.6% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 3 to Tier 4, with a cross-plan average of Tier 3.8.
Real-world access to amphetamine sulfate 5 MG Oral Tablet depends on utilization management as much as tier placement: 100% 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 203 Part D beneficiaries filled amphetamine sulfate 5 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $182,384 and an average per-beneficiary annual cost of $898.44. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry amphetamine sulfate 5 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 4
- Plans covering
- 29
- Coverage rate
- 0.6%
- Tier range
- Tier 3 – Tier 4
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 203
- Total spending
- $182,384
- Avg per beneficiary
- $898.44
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering amphetamine sulfate 5 MG Oral Tablet
29 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Network Health Select (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T3 | Yes | $0 | WI |
| Network Health Go (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T3 | Yes | $0 | WI |
| Network Health Anywhere (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T3 | Yes | $0 | WI |
| Network Health Choice (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T3 | Yes | $0 | WI |
| Network Health Zero (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T3 | Yes | $0 | WI |
| Network Health Cares (PPO D-SNP) | NETWORK HEALTH INSURANCE CORPORATION | T3 | Yes | $21.10 | WI |
| Network Health PlusRx (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T3 | Yes | $38.60 | WI |
| Network Health PremierRx (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T3 | Yes | $92.80 | WI |
| Medicare BlueEssential (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $0 | NY |
| Medicare BlueActive (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $0 | NY |
| Medicare BlueVital (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $0 | NY |
| Univera SeniorChoice Basic (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $0 | NY |
| Univera SeniorChoice Extra (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $0 | NY |
| Medicare Blue Choice Core (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $0 | NY |
| Univera Medicare Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T4 | Yes | $0 | NY |
| Medicare Blue Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T4 | Yes | $0 | NY |
| CDPHP $0 Medicare Rx (HMO) | CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | T4 | Yes | $0 | NY |
| Univera SeniorChoice Core (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $33.00 | NY |
| Univera SeniorChoice Advanced (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $36.90 | NY |
| Medicare BlueClassic (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $51.00 | NY |
| Univera SeniorChoice Secure (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $54.90 | NY |
| Medicare BlueBalanced (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $55.00 | NY |
| Medicare Blue Choice Prime (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $55.00 | NY |
| Univera SeniorChoice Value Plus (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $58.60 | NY |
| Medicare BlueEnhanced (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $70.30 | NY |
| Medicare BluePlus (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $86.40 | NY |
| CDPHP Clear Rx (HMO) | CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | T4 | Yes | $100.00 | NY |
| CDPHP Choice Rx (HMO) | CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | T4 | Yes | $135.00 | NY |
| Medicare Blue Choice Optimum (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | Yes | $146.00 | NY |
Frequently Asked Questions
Is amphetamine sulfate 5 MG Oral Tablet covered by Medicare Part D?
Yes, amphetamine sulfate 5 MG Oral Tablet is covered by 29 Medicare Part D plans (0.6% of all Part D formularies).
What tier is amphetamine sulfate 5 MG Oral Tablet on Medicare Part D plans?
amphetamine sulfate 5 MG Oral Tablet averages Tier 3.8 across Part D plans, ranging from Tier 3 to Tier 4.
Does amphetamine sulfate 5 MG Oral Tablet require prior authorization?
100% of Part D formularies require prior authorization for amphetamine sulfate 5 MG Oral Tablet. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on amphetamine sulfate 5 MG Oral Tablet?
In 2023, total Medicare Part D spending on amphetamine sulfate 5 MG Oral Tablet was $182,384, covering 203 beneficiaries. The average spend per beneficiary was $898.44.
Read our methodology - how this data is sourced, computed, and verified.