ampicillin 2000 MG Injection
ampicillin
RxCUI: 1721476
What the CMS Formulary Data Shows for ampicillin 2000 MG Injection
Per the CMS 2026 Part D formulary file, ampicillin 2000 MG Injection (RxNorm concept RXCUI 1721476, generic name ampicillin) appears on 224 distinct formulary files spanning 4,489 Medicare Part D plan offerings - 88.6% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 2.8.
Real-world access to ampicillin 2000 MG Injection depends on utilization management as much as tier placement: 11.6% 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 2000 MG Injection in 2023, with total plan-and-beneficiary spending of $4,689,949 and an average per-beneficiary annual cost of $1,213.76. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry ampicillin 2000 MG Injection today.
Coverage Details
- Formularies covering
- 224
- Plans covering
- 4,489
- Coverage rate
- 88.6%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 11.6% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 3,864
- Total spending
- $4,689,949
- Avg per beneficiary
- $1,213.76
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering ampicillin 2000 MG Injection
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 |
| 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 |
| Healthfirst CompleteCare (HMO D-SNP) | HEALTHFIRST HEALTH PLAN, INC. | T1 | No | $0 | NY |
| IMCare Classic (HMO D-SNP) | ITASCA MEDICAL CARE | T1 | No | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | HOPKINS HEALTH ADVANTAGE, INC. | T1 | No | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | METROPLUS HEALTH PLAN, INC. | T1 | No | $0 | NY |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | UPPER PENINSULA HEALTH PLAN, LLC | T1 | Yes | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | CARESOURCE GEORGIA CO. | T1 | Yes | $0 | GA |
| Senior Whole Health SCO (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| Molina One Care (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP CARESOURCE | T1 | Yes | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | PRUITTHEALTH PREMIER, INC. | T1 | No | $0 | GA |
| BlueAdvantage Sapphire (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T1 | No | $0 | TN |
| BlueAdvantage Sapphire (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T1 | No | $0 | TN |
| BlueAdvantage Garnet (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T1 | No | $0 | TN |
| BlueAdvantage Garnet (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T1 | No | $0 | TN |
| BlueAdvantage Sapphire (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T1 | No | $0 | TN |
| BlueAdvantage Sapphire (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T1 | No | $0 | GA |
| BlueAdvantage Total Heart and Diabetes (PPO C-SNP) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T1 | No | $0 | GA, TN |
| BlueAdvantage Total Heart and Diabetes (PPO C-SNP) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T1 | No | $0 | TN |
| Simpra Advantage Dual Care (PPO D-SNP) | SIMPRA ADVANTAGE, INC. | T1 | No | $0 | AL |
| CareAdvantage (HMO D-SNP) | SAN MATEO HEALTH COMMISSION | T1 | No | $0 | CA |
| NaviCare (HMO D-SNP) | FALLON COMMUNITY HEALTH PLAN | T1 | No | $0 | MA |
| SeniorCare Complete (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | ALAMEDA ALLIANCE FOR HEALTH | T1 | No | $0 | CA |
| CCA One Care (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | T1 | No | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | T1 | No | $0 | MA |
| 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 |
| Abilis Health Community (HMO I-SNP) | SIGNATURE ADVANTAGE, LLC | T1 | No | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | ARKANSAS SUPERIOR SELECT, INC. | T1 | No | $0 | AR |
| Community Care's Partnership Program (HMO D-SNP) | COMMUNITY CARE HEALTH PLAN, INC. | T1 | No | $0 | WI |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T1 | No | $0 | CA |
| Mass General Brigham SCO (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | No | $0 | MA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $0 | PA |
Frequently Asked Questions
Is ampicillin 2000 MG Injection covered by Medicare Part D?
Yes, ampicillin 2000 MG Injection is covered by 4,489 Medicare Part D plans (88.6% of all Part D formularies).
What tier is ampicillin 2000 MG Injection on Medicare Part D plans?
ampicillin 2000 MG Injection averages Tier 2.8 across Part D plans, ranging from Tier 1 to Tier 6.
Does ampicillin 2000 MG Injection require prior authorization?
11.6% of Part D formularies require prior authorization for ampicillin 2000 MG Injection. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on ampicillin 2000 MG Injection?
In 2023, total Medicare Part D spending on ampicillin 2000 MG Injection was $4,689,949, covering 3,864 beneficiaries. The average spend per beneficiary was $1,213.76.
Read our methodology - how this data is sourced, computed, and verified.