codeine sulfate 30 MG Oral Tablet

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codeine sulfate

RxCUI: 997287

Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.
23.7%
Plan Coverage
1,201
Plans Covering
T2.8
Avg Tier
0%
Prior Auth Required

What the CMS Formulary Data Shows for codeine sulfate 30 MG Oral Tablet

Per the CMS 2026 Part D formulary file, codeine sulfate 30 MG Oral Tablet (RxNorm concept RXCUI 997287, generic name codeine sulfate) appears on 56 distinct formulary files spanning 1,201 Medicare Part D plan offerings - 23.7% 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 2.8.

Real-world access to codeine sulfate 30 MG Oral Tablet depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 83.9% apply quantity limits.

Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 3,569 Part D beneficiaries filled codeine sulfate 30 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $1,122,751 and an average per-beneficiary annual cost of $314.58. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry codeine sulfate 30 MG Oral Tablet today.

Coverage Details

Formularies covering
56
Plans covering
1,201
Coverage rate
23.7%
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
83.9% of formularies

2023 Medicare Spending

Beneficiaries
3,569
Total spending
$1,122,751
Avg per beneficiary
$314.58

Tier Distribution Across Plans

38 plans
Tier 1, Preferred Generic
62 plans
Tier 2, Generic

Medicare Advantage Plans (MA-PD) Covering codeine sulfate 30 MG Oral Tablet

100 Medicare Advantage plans with Part D drug coverage include this drug.

Plan Insurer Tier PA Premium States
Gold Coast Health Plan Total Care Advantage (HMO D-SNP) Ventura County Medi-Cal Managed Care Commission T1 No $0 CA
MCS Classicare RxMax (HMO) MCS ADVANTAGE, INC. T1 No $0 PR
MCS Classicare Platino Ideal (HMO D-SNP) MCS ADVANTAGE, INC. T1 No $0 PR
MCS Classicare Efectivo (HMO) MCS ADVANTAGE, INC. T1 No $0 PR
MCS Classicare Essential (HMO-POS) MCS ADVANTAGE, INC. T1 No $0 PR
MCS Classicare Platino Progreso (HMO D-SNP) MCS ADVANTAGE, INC. T1 No $0 PR
MCS Classicare Primero (HMO C-SNP) MCS ADVANTAGE, INC. T1 No $0 PR
MCS Classicare Firme (HMO) MCS ADVANTAGE, INC. T1 No $0 PR
MCS Classicare En Tu Hogar (HMO) MCS ADVANTAGE, INC. T1 No $0 PR
MCS Classicare Hero (HMO) MCS ADVANTAGE, INC. T1 No $0 PR
MCS Classicare Platino Total (HMO D-SNP) MCS ADVANTAGE, INC. T1 No $0 PR
MCS Classicare InteliCare (HMO) MCS ADVANTAGE, INC. T1 No $0 PR
MCS Classicare Platino Maximo (HMO D-SNP) MCS ADVANTAGE, INC. T1 No $0 PR
MCS Classicare Excede (HMO) MCS ADVANTAGE, INC. T1 No $0 PR
MCS Classicare Estrella (HMO) MCS ADVANTAGE, INC. T1 No $0 PR
MCS Classicare Platino Superior (HMO D-SNP) MCS ADVANTAGE, INC. T1 No $0 PR
MCS Classicare Platino 185 (HMO D-SNP) MCS ADVANTAGE, INC. T1 No $0 PR
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
SecureBlue (HMO D-SNP) HMO Minnesota T1 No $0 MN
Hamaspik Medicare Choice (HMO D-SNP) HAMASPIK, INC. T1 No $0 NY
PHP (HMO C-SNP) AIDS HEALTHCARE FOUNDATION T1 No $0 CA
VNS Health Total (HMO D-SNP) VNS CHOICE T1 No $0 NY
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
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) GATEWAY HEALTH PLAN, INC. T1 No $0 PA
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) GATEWAY HEALTH PLAN, INC. T1 No $0 PA
Highmark Health Options Duals (HMO D-SNP) HIGHMARK HEALTH OPTIONS WEST VIRGINIA INC. T1 No $0 WV
Highmark Health Options Duals (HMO D-SNP) HIGHMARK BCBSD, INC. T1 No $0 DE
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) HCSC INSURANCE SERVICES COMPANY T1 No $4.80 TX
Gold Dialysis & Kidney Complete (HMO-POS C-SNP) GOLD KIDNEY OF FLORIDA INC T1 No $4.80 FL
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) GHS INSURANCE COMPANY T1 No $5.00 OK
Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) GATEWAY HEALTH PLAN, INC. T1 No $13.10 PA
Gold Dialysis & Kidney Complete (HMO-POS C-SNP) GOLD KIDNEY OF ARIZONA T1 No $17.00 AZ
Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) GATEWAY HEALTH PLAN, INC. T1 No $17.60 PA
Highmark Health Options Duals Select (HMO D-SNP) HIGHMARK BCBSD, INC. T1 No $31.20 DE
Hamaspik Medicare Select (HMO D-SNP) HAMASPIK, INC. T1 No $34.50 NY
VNS Health EasyCare Plus (HMO D-SNP) VNS CHOICE T1 No $51.60 NY
Freedom VIP Care (HMO C-SNP) FREEDOM HEALTH, INC. T2 No $0 FL
Freedom VIP Savings (HMO C-SNP) FREEDOM HEALTH, INC. T2 No $0 FL
Freedom VIP Savings (HMO C-SNP) FREEDOM HEALTH, INC. T2 No $0 FL
Freedom VIP Rewards (HMO C-SNP) FREEDOM HEALTH, INC. T2 No $0 FL
Freedom VIP Rewards (HMO C-SNP) FREEDOM HEALTH, INC. T2 No $0 FL
Optimum Diamond Rewards (HMO C-SNP) OPTIMUM HEALTHCARE, INC. T2 No $0 FL
Optimum Diamond Savings (HMO C-SNP) OPTIMUM HEALTHCARE, INC. T2 No $0 FL
Optimum Diamond Rewards (HMO C-SNP) OPTIMUM HEALTHCARE, INC. T2 No $0 FL
Optimum Diamond (HMO C-SNP) OPTIMUM HEALTHCARE, INC. T2 No $0 FL
Freedom Medi-Medi Partial (HMO D-SNP) FREEDOM HEALTH, INC. T2 No $0 FL
Freedom Medi-Medi Full (HMO D-SNP) FREEDOM HEALTH, INC. T2 No $0 FL
Optimum Emerald Partial (HMO D-SNP) OPTIMUM HEALTHCARE, INC. T2 No $0 FL

Frequently Asked Questions

Is codeine sulfate 30 MG Oral Tablet covered by Medicare Part D?

Yes, codeine sulfate 30 MG Oral Tablet is covered by 1,201 Medicare Part D plans (23.7% of all Part D formularies).

What tier is codeine sulfate 30 MG Oral Tablet on Medicare Part D plans?

codeine sulfate 30 MG Oral Tablet averages Tier 2.8 across Part D plans, ranging from Tier 1 to Tier 4.

Does codeine sulfate 30 MG Oral Tablet require prior authorization?

0% of Part D formularies require prior authorization for codeine sulfate 30 MG Oral Tablet. Step therapy: 0%. Quantity limits: 83.9%.

How much does Medicare spend on codeine sulfate 30 MG Oral Tablet?

In 2023, total Medicare Part D spending on codeine sulfate 30 MG Oral Tablet was $1,122,751, covering 3,569 beneficiaries. The average spend per beneficiary was $314.58.

Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare Editorial