asenapine 2.5 MG Sublingual Tablet [Saphris]
asenapine
RxCUI: 1606490
What the CMS Formulary Data Shows for asenapine 2.5 MG Sublingual Tablet [Saphris]
Per the CMS 2026 Part D formulary file, asenapine 2.5 MG Sublingual Tablet [Saphris] (RxNorm concept RXCUI 1606490, generic name asenapine) appears on 4 distinct formulary files spanning 28 Medicare Part D plan offerings - 0.6% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.5.
Real-world access to asenapine 2.5 MG Sublingual Tablet [Saphris] depends on utilization management as much as tier placement: 50% of covering formularies require prior authorization. 50% require step therapy. 25% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 714 Part D beneficiaries filled asenapine 2.5 MG Sublingual Tablet [Saphris] in 2023, with total plan-and-beneficiary spending of $4,972,991 and an average per-beneficiary annual cost of $6,964.97. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry asenapine 2.5 MG Sublingual Tablet [Saphris] today.
Coverage Details
- Formularies covering
- 4
- Plans covering
- 28
- Coverage rate
- 0.6%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 50% of formularies
- Step therapy required
- 50% of formularies
- Quantity limits
- 25% of formularies
2023 Medicare Spending
- Beneficiaries
- 714
- Total spending
- $4,972,991
- Avg per beneficiary
- $6,964.97
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering asenapine 2.5 MG Sublingual Tablet [Saphris]
28 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $0 | NY |
| Platino Blindao (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | No | $0 | PR |
| Platino Enlace (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | No | $0 | PR |
| PLATINO ADVANCE (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | No | $0 | PR |
| PLATINO PLUS (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | No | $0 | PR |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $34.50 | NY |
| MMM Supremo (HMO C-SNP) | MMM HEALTHCARE, LLC | T4 | Yes | $0 | PR |
| MMM Diamante Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T4 | Yes | $0 | PR |
| MMM Unico (HMO-POS) | MMM HEALTHCARE, LLC | T4 | Yes | $0 | PR |
| MMM Elite (HMO-POS) | MMM HEALTHCARE, LLC | T4 | Yes | $0 | PR |
| MMM Deluxe (HMO-POS) | MMM HEALTHCARE, LLC | T4 | Yes | $0 | PR |
| MMM Dorado Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T4 | Yes | $0 | PR |
| PMC Premier Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T4 | Yes | $0 | PR |
| PMC Max (HMO-POS) | MMM HEALTHCARE, LLC | T4 | Yes | $0 | PR |
| MMM Plenitud (HMO-POS) | MMM HEALTHCARE, LLC | T4 | Yes | $0 | PR |
| MMM Valioso (HMO-POS) | MMM HEALTHCARE, LLC | T4 | Yes | $0 | PR |
| MMM Combo Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T4 | Yes | $0 | PR |
| MMM Flexi Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T4 | Yes | $0 | PR |
| MMM Grandioso (HMO-POS) | MMM HEALTHCARE, LLC | T4 | Yes | $0 | PR |
| MMM Mega Flex (HMO-POS) | MMM HEALTHCARE, LLC | T4 | Yes | $0 | PR |
| MMM Relax Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T4 | Yes | $0 | PR |
| MMM Balance (HMO-POS) | MMM HEALTHCARE, LLC | T4 | Yes | $0 | PR |
| Óptimo Plus (PPO) | TRIPLE S ADVANTAGE, INC. | T4 | No | $0 | PR |
| Contigo Plus (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T4 | No | $0 | PR |
| Brillante (HMO-POS) | TRIPLE S ADVANTAGE, INC. | T4 | No | $0 | PR |
| Enlace Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T4 | No | $0 | PR |
| ContigoEnMente (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T4 | No | $0 | PR |
| Ahorro Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T4 | No | $0 | PR |
Frequently Asked Questions
Is asenapine 2.5 MG Sublingual Tablet [Saphris] covered by Medicare Part D?
Yes, asenapine 2.5 MG Sublingual Tablet [Saphris] is covered by 28 Medicare Part D plans (0.6% of all Part D formularies).
What tier is asenapine 2.5 MG Sublingual Tablet [Saphris] on Medicare Part D plans?
asenapine 2.5 MG Sublingual Tablet [Saphris] averages Tier 2.5 across Part D plans, ranging from Tier 1 to Tier 4.
Does asenapine 2.5 MG Sublingual Tablet [Saphris] require prior authorization?
50% of Part D formularies require prior authorization for asenapine 2.5 MG Sublingual Tablet [Saphris]. Step therapy: 50%. Quantity limits: 25%.
How much does Medicare spend on asenapine 2.5 MG Sublingual Tablet [Saphris]?
In 2023, total Medicare Part D spending on asenapine 2.5 MG Sublingual Tablet [Saphris] was $4,972,991, covering 714 beneficiaries. The average spend per beneficiary was $6,964.97.
Read our methodology - how this data is sourced, computed, and verified.