Medicare Part D coverage · ampicillin · RxCUI 789980
ampicillin 100 MG/ML Injectable Solution
Per the CMS 2026 Part D formulary file, ampicillin 100 MG/ML Injectable Solution is covered by 4,910 Medicare Part D plans (97.2% of enrollable products), averaging Tier 2.7, with prior authorization required on 10.3% of covering formularies.
- 97.2%
- Plan coverage
- 4,910
- Plans covering
- T2.7
- Avg tier
- 10.3%
- Prior auth required
What the CMS Formulary Data Shows for ampicillin 100 MG/ML Injectable Solution
Per the CMS 2026 Part D formulary file, ampicillin 100 MG/ML Injectable Solution (RxNorm concept RXCUI 789980, generic name ampicillin) appears on 300 distinct formulary files spanning 4,910 Medicare Part D plan offerings - 97.2% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 2.7.
Real-world access to ampicillin 100 MG/ML Injectable Solution depends on utilization management as much as tier placement: 10.3% 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 3,864 Part D beneficiaries filled ampicillin 100 MG/ML Injectable Solution in 2023, with total plan-and-beneficiary spending of $4,683,566 and an average per-beneficiary annual cost of $1,212.10. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry ampicillin 100 MG/ML Injectable Solution today.
Coverage Details
- Formularies covering
- 300
- Plans covering
- 4,910
- Coverage rate
- 97.2%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 10.3% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 3,864
- Total spending
- $4,683,566
- Avg per beneficiary
- $1,212.10
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering ampicillin 100 MG/ML Injectable Solution
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 |
| Freedom VIP Care (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Savings (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Freedom Medi-Medi Partial (HMO D-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Medi-Medi Full (HMO D-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Optimum Emerald Partial (HMO D-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Emerald Full (HMO D-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
Show the next 30 plans
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Máximo (HMO-POS) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Máximo (HMO-POS) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Platinum Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Gold Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Savings COPD (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Gold Plus Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | No | $0 | FL |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | Yes | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | Yes | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | Yes | $0 | NJ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | No | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | No | $0 | AZ |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is ampicillin 100 MG/ML Injectable Solution covered by Medicare Part D?
Yes, ampicillin 100 MG/ML Injectable Solution is covered by 4,910 Medicare Part D plans (97.2% of all Part D formularies).
What tier is ampicillin 100 MG/ML Injectable Solution on Medicare Part D plans?
ampicillin 100 MG/ML Injectable Solution averages Tier 2.7 across Part D plans, ranging from Tier 1 to Tier 6.
Does ampicillin 100 MG/ML Injectable Solution require prior authorization?
10.3% of Part D formularies require prior authorization for ampicillin 100 MG/ML Injectable Solution. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on ampicillin 100 MG/ML Injectable Solution?
In 2023, total Medicare Part D spending on ampicillin 100 MG/ML Injectable Solution was $4,683,566, covering 3,864 beneficiaries. The average spend per beneficiary was $1,212.10.
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
- tadalafil 5 MG Oral Tablet T2.7
- theophylline 300 MG Extended Release Oral Tablet T2.7
- timolol 20 MG Oral Tablet T2.7
- 1000 ML glucose 50 MG/ML / potassium chloride 0.02 MEQ/ML / sodium chloride 4.5 MG/ML Injection T2.7
- 20 ML potassium chloride 2 MEQ/ML Injection T2.7
- fluocinolone acetonide 0.1 MG/ML Topical Oil T2.7
Similar prior-authorization rate
- 30/70 Release 24 HR methylphenidate hydrochloride 10 MG Extended Release Oral Capsule 10.3% PA
- 120 ACTUAT formoterol fumarate 0.005 MG/ACTUAT / mometasone furoate 0.1 MG/ACTUAT Metered Dose Inhaler [Dulera] 10.4% PA
- 250 ML moxifloxacin 1.6 MG/ML Injection 10.4% PA
- lomustine 100 MG Oral Capsule [Gleostine] 10.2% PA
- lomustine 40 MG Oral Capsule [Gleostine] 10.2% PA
- lomustine 10 MG Oral Capsule [Gleostine] 10.2% PA