atropine sulfate 0.025 MG / diphenoxylate hydrochloride 2.5 MG Oral Tablet [Lomotil]
atropine sulfate
RxCUI: 1190641
What the CMS Formulary Data Shows for atropine sulfate 0.025 MG / diphenoxylate hydrochloride 2.5 MG Oral Tablet [Lomotil]
Per the CMS 2026 Part D formulary file, atropine sulfate 0.025 MG / diphenoxylate hydrochloride 2.5 MG Oral Tablet [Lomotil] (RxNorm concept RXCUI 1190641, generic name atropine sulfate) appears on 1 distinct formulary file spanning 6 Medicare Part D plan offerings - 0.1% 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 atropine sulfate 0.025 MG / diphenoxylate hydrochloride 2.5 MG Oral Tablet [Lomotil] 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 109,532 Part D beneficiaries filled atropine sulfate 0.025 MG / diphenoxylate hydrochloride 2.5 MG Oral Tablet [Lomotil] in 2023, with total plan-and-beneficiary spending of $9,184,134 and an average per-beneficiary annual cost of $83.85. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry atropine sulfate 0.025 MG / diphenoxylate hydrochloride 2.5 MG Oral Tablet [Lomotil] today.
Coverage Details
- Formularies covering
- 1
- Plans covering
- 6
- Coverage rate
- 0.1%
- Tier range
- Tier 4, Non-Preferred
- 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
- 109,532
- Total spending
- $9,184,134
- Avg per beneficiary
- $83.85
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering atropine sulfate 0.025 MG / diphenoxylate hydrochloride 2.5 MG Oral Tablet [Lomotil]
6 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Óptimo Plus (PPO) | TRIPLE S ADVANTAGE, INC. | T4 | Yes | $0 | PR |
| Contigo Plus (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T4 | Yes | $0 | PR |
| Brillante (HMO-POS) | TRIPLE S ADVANTAGE, INC. | T4 | Yes | $0 | PR |
| Enlace Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T4 | Yes | $0 | PR |
| ContigoEnMente (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T4 | Yes | $0 | PR |
| Ahorro Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T4 | Yes | $0 | PR |
Frequently Asked Questions
Is atropine sulfate 0.025 MG / diphenoxylate hydrochloride 2.5 MG Oral Tablet [Lomotil] covered by Medicare Part D?
Yes, atropine sulfate 0.025 MG / diphenoxylate hydrochloride 2.5 MG Oral Tablet [Lomotil] is covered by 6 Medicare Part D plans (0.1% of all Part D formularies).
What tier is atropine sulfate 0.025 MG / diphenoxylate hydrochloride 2.5 MG Oral Tablet [Lomotil] on Medicare Part D plans?
atropine sulfate 0.025 MG / diphenoxylate hydrochloride 2.5 MG Oral Tablet [Lomotil] averages Tier 4 across Part D plans, ranging from Tier 4 to Tier 4.
Does atropine sulfate 0.025 MG / diphenoxylate hydrochloride 2.5 MG Oral Tablet [Lomotil] require prior authorization?
100% of Part D formularies require prior authorization for atropine sulfate 0.025 MG / diphenoxylate hydrochloride 2.5 MG Oral Tablet [Lomotil]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on atropine sulfate 0.025 MG / diphenoxylate hydrochloride 2.5 MG Oral Tablet [Lomotil]?
In 2023, total Medicare Part D spending on atropine sulfate 0.025 MG / diphenoxylate hydrochloride 2.5 MG Oral Tablet [Lomotil] was $9,184,134, covering 109,532 beneficiaries. The average spend per beneficiary was $83.85.
Read our methodology - how this data is sourced, computed, and verified.