Medicare Part D coverage · caffeine · RxCUI 1293504
caffeine 100 MG / ergotamine tartrate 1 MG Oral Tablet
Per the CMS 2026 Part D formulary file, caffeine 100 MG / ergotamine tartrate 1 MG Oral Tablet is covered by 4,702 Medicare Part D plans (93.1% of enrollable products), averaging Tier 2.5, with prior authorization required on 33.2% of covering formularies.
- 93.1%
- Plan coverage
- 4,702
- Plans covering
- T2.5
- Avg tier
- 33.2%
- Prior auth required
What the CMS Formulary Data Shows for caffeine 100 MG / ergotamine tartrate 1 MG Oral Tablet
Per the CMS 2026 Part D formulary file, caffeine 100 MG / ergotamine tartrate 1 MG Oral Tablet (RxNorm concept RXCUI 1293504, generic name caffeine) appears on 232 distinct formulary files spanning 4,702 Medicare Part D plan offerings - 93.1% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 3, with a cross-plan average of Tier 2.5.
Real-world access to caffeine 100 MG / ergotamine tartrate 1 MG Oral Tablet depends on utilization management as much as tier placement: 33.2% of covering formularies require prior authorization. 0% require step therapy. 50.9% apply quantity limits.
Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry caffeine 100 MG / ergotamine tartrate 1 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 232
- Plans covering
- 4,702
- Coverage rate
- 93.1%
- Tier range
- Tier 1 – Tier 3
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 33.2% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 50.9% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering caffeine 100 MG / ergotamine tartrate 1 MG Oral Tablet
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $0 | NJ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | Yes | $0 | NY |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | No | $0 | GA |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | No | $0 | MI |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | No | $0 | CA |
Show the next 30 plans
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | No | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | No | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | Yes | $0 | CA |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $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 Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $0 | MO |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| 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 |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Florida Complete Care (HMO I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | No | $4.80 | FL |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Hcsc Insurance Services Company | T1 | No | $4.80 | TX |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is caffeine 100 MG / ergotamine tartrate 1 MG Oral Tablet covered by Medicare Part D?
Yes, caffeine 100 MG / ergotamine tartrate 1 MG Oral Tablet is covered by 4,702 Medicare Part D plans (93.1% of all Part D formularies).
What tier is caffeine 100 MG / ergotamine tartrate 1 MG Oral Tablet on Medicare Part D plans?
caffeine 100 MG / ergotamine tartrate 1 MG Oral Tablet averages Tier 2.5 across Part D plans, ranging from Tier 1 to Tier 3.
Does caffeine 100 MG / ergotamine tartrate 1 MG Oral Tablet require prior authorization?
33.2% of Part D formularies require prior authorization for caffeine 100 MG / ergotamine tartrate 1 MG Oral Tablet. Step therapy: 0%. Quantity limits: 50.9%.
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
- anagrelide 1 MG Oral Capsule T2.5
- 100 ML sodium chloride 9 MG/ML Injection T2.5
- 12 HR acetazolamide 500 MG Extended Release Oral Capsule T2.5
- 1000 ML potassium chloride 0.02 MEQ/ML / sodium chloride 9 MG/ML Injection T2.5
- 21 DAY ethinyl estradiol 0.000625 MG/HR / etonogestrel 0.005 MG/HR Vaginal System [Enilloring] T2.5
- {28 (ethinyl estradiol 0.005 MG / norethindrone acetate 1 MG Oral Tablet) } Pack T2.5
Similar prior-authorization rate
- lumateperone 42 MG Oral Capsule [Caplyta] 33.2% PA
- 2 ML methotrexate 25 MG/ML Injection 33.2% PA
- clomipramine hydrochloride 25 MG Oral Capsule 33.2% PA
- pretomanid 200 MG Oral Tablet 33.3% PA
- meperidine hydrochloride 50 MG Oral Tablet 33.3% PA
- aspirin 325 MG / butalbital 50 MG / caffeine 40 MG / codeine phosphate 30 MG Oral Capsule [Ascomp] 33.3% PA