carbamazepine 20 MG/ML Oral Suspension [Tegretol]
carbamazepine
RxCUI: 308971
What the CMS Formulary Data Shows for carbamazepine 20 MG/ML Oral Suspension [Tegretol]
Per the CMS 2026 Part D formulary file, carbamazepine 20 MG/ML Oral Suspension [Tegretol] (RxNorm concept RXCUI 308971, generic name carbamazepine) appears on 3 distinct formulary files spanning 92 Medicare Part D plan offerings - 1.8% 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 2.7.
Real-world access to carbamazepine 20 MG/ML Oral Suspension [Tegretol] depends on utilization management as much as tier placement: 0% 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 135,324 Part D beneficiaries filled carbamazepine 20 MG/ML Oral Suspension [Tegretol] in 2023, with total plan-and-beneficiary spending of $52,182,713 and an average per-beneficiary annual cost of $385.61. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry carbamazepine 20 MG/ML Oral Suspension [Tegretol] today.
Coverage Details
- Formularies covering
- 3
- Plans covering
- 92
- Coverage rate
- 1.8%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 135,324
- Total spending
- $52,182,713
- Avg per beneficiary
- $385.61
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering carbamazepine 20 MG/ML Oral Suspension [Tegretol]
92 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 | No | $0 | NY |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $34.50 | NY |
| SCAN Connections (HMO D-SNP) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Connections at Home (HMO D-SNP) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN NEVADA, INC. | T3 | No | $0 | NV |
| SCAN Balance (HMO C-SNP) | SCAN HEALTH PLAN NEVADA, INC. | T3 | No | $0 | NV |
| SCAN Strive (HMO C-SNP) | SCAN HEALTH PLAN NEVADA, INC. | T3 | No | $0 | NV |
| SCAN MyChoice (HMO) | SCAN HEALTH PLAN NEVADA, INC. | T3 | No | $0 | NV |
| SCAN Classic (HMO) | SCAN DESERT HEALTH PLAN, INC. | T3 | No | $0 | AZ |
| SCAN Balance (HMO C-SNP) | SCAN DESERT HEALTH PLAN, INC. | T3 | No | $0 | AZ |
| SCAN Embrace (HMO-POS I-SNP) | SCAN DESERT HEALTH PLAN, INC. | T3 | No | $0 | AZ |
| SCAN Strive (HMO C-SNP) | SCAN DESERT HEALTH PLAN, INC. | T3 | No | $0 | AZ |
| SCAN MyChoice (HMO) | SCAN DESERT HEALTH PLAN, INC. | T3 | No | $0 | AZ |
| SCAN Classic WA (HMO) | SCAN HEALTH PLAN (WA) | T3 | No | $0 | WA |
| SCAN MyChoice WA (HMO) | SCAN HEALTH PLAN (WA) | T3 | No | $0 | WA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN (NM) | T3 | No | $0 | NM |
| SCAN Balance (HMO C-SNP) | SCAN HEALTH PLAN (NM) | T3 | No | $0 | NM |
| SCAN Strive (HMO C-SNP) | SCAN HEALTH PLAN (NM) | T3 | No | $0 | NM |
| SCAN MyChoice (HMO) | SCAN HEALTH PLAN (NM) | T3 | No | $0 | NM |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Balance (HMO C-SNP) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Prime (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Balance (HMO C-SNP) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Balance (HMO C-SNP) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Alta (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Venture (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Venture (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Embrace (HMO I-SNP) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Embrace (HMO I-SNP) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Embrace (HMO-POS I-SNP) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Affirm partnered with Included LGBTQ+ Health (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Affirm partnered with Included LGBTQ+ Health (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Strive (HMO C-SNP) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Strive (HMO C-SNP) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Inspired by women for women (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Balance (HMO C-SNP) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Balance (HMO C-SNP) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Balance (HMO C-SNP) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Balance (HMO C-SNP) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN Affirm partnered with Included LGBTQ+ Health (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
| SCAN MyChoice (HMO) | SCAN HEALTH PLAN | T3 | No | $0 | CA |
Frequently Asked Questions
Is carbamazepine 20 MG/ML Oral Suspension [Tegretol] covered by Medicare Part D?
Yes, carbamazepine 20 MG/ML Oral Suspension [Tegretol] is covered by 92 Medicare Part D plans (1.8% of all Part D formularies).
What tier is carbamazepine 20 MG/ML Oral Suspension [Tegretol] on Medicare Part D plans?
carbamazepine 20 MG/ML Oral Suspension [Tegretol] averages Tier 2.7 across Part D plans, ranging from Tier 1 to Tier 4.
Does carbamazepine 20 MG/ML Oral Suspension [Tegretol] require prior authorization?
0% of Part D formularies require prior authorization for carbamazepine 20 MG/ML Oral Suspension [Tegretol]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on carbamazepine 20 MG/ML Oral Suspension [Tegretol]?
In 2023, total Medicare Part D spending on carbamazepine 20 MG/ML Oral Suspension [Tegretol] was $52,182,713, covering 135,324 beneficiaries. The average spend per beneficiary was $385.61.
Read our methodology - how this data is sourced, computed, and verified.