Medicare Part D coverage · dexmethylphenidate hydrochloride · RxCUI 899518
dexmethylphenidate hydrochloride 5 MG Oral Tablet
Per the CMS 2026 Part D formulary file, dexmethylphenidate hydrochloride 5 MG Oral Tablet is covered by 4,555 Medicare Part D plans (90.2% of enrollable products), averaging Tier 2.4, with prior authorization required on 39.1% of covering formularies.
- 90.2%
- Plan coverage
- 4,555
- Plans covering
- T2.4
- Avg tier
- 39.1%
- Prior auth required
What the CMS Formulary Data Shows for dexmethylphenidate hydrochloride 5 MG Oral Tablet
Per the CMS 2026 Part D formulary file, dexmethylphenidate hydrochloride 5 MG Oral Tablet (RxNorm concept RXCUI 899518, generic name dexmethylphenidate hydrochloride) appears on 256 distinct formulary files spanning 4,555 Medicare Part D plan offerings - 90.2% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.4.
Real-world access to dexmethylphenidate hydrochloride 5 MG Oral Tablet depends on utilization management as much as tier placement: 39.1% of covering formularies require prior authorization. 0% require step therapy. 79.7% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 9,197 Part D beneficiaries filled dexmethylphenidate hydrochloride 5 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $6,100,623 and an average per-beneficiary annual cost of $663.33. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry dexmethylphenidate hydrochloride 5 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 256
- Plans covering
- 4,555
- Coverage rate
- 90.2%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 39.1% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 79.7% of formularies
2023 Medicare Spending
- Beneficiaries
- 9,197
- Total spending
- $6,100,623
- Avg per beneficiary
- $663.33
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering dexmethylphenidate hydrochloride 5 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 |
| 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 |
| 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 |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | No | $0 | GA |
| KeyCare Advantage Plus (HMO C-SNP) | Isnp Ventures, LLC | T1 | No | $0 | MD |
| Premier Care (HMO-POS I-SNP) | Lifeworks Advantage, LLC | T1 | No | $0 | VA |
| Premier Care (HMO I-SNP) | Align Senior Care California Inc. | T1 | No | $0 | CA |
| Advantage Care (HMO) | Align Senior Care California Inc. | T1 | No | $0 | CA |
| Premier Care (HMO-POS I-SNP) | Align Senior Care MI, LLC | T1 | No | $0 | MI |
| Premier Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | No | $0 | FL |
Show the next 30 plans
| Perennial Advantage Freedom (HMO-POS) | Perennial Advantage OF Colorado, Inc. | T1 | No | $0 | CO |
| Perennial Advantage Premier (HMO-POS I-SNP) | Perennial Advantage OF Colorado, Inc. | T1 | No | $0 | CO |
| Perennial Advantage Freedom (HMO) | Perennial Advantage OF Colorado, Inc. | T1 | No | $0 | PA |
| Perennial Advantage Premier (HMO I-SNP) | Perennial Advantage OF Colorado, Inc. | T1 | No | $0 | PA |
| Perennial Advantage Freedom (HMO-POS) | Perennial Advantage OF Ohio, Inc. | T1 | No | $0 | OH |
| Perennial Advantage Premier (HMO-POS I-SNP) | Perennial Advantage OF Ohio, Inc. | T1 | No | $0 | OH |
| ProCare Advantage - Diabetes Care Management (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | No | $0 | TX |
| PruittHealth Premier Advantage (HMO I-SNP) | Pruitthealth Premier, Inc. | T1 | No | $0 | GA |
| Senior Health Plan Silver Plus (HMO) | Communitycare Government Programs, Inc. | T1 | No | $0 | OK |
| Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) | Communitycare Government Programs, Inc. | T1 | No | $0 | OK |
| Community First Medicare Advantage Alamo Plan (HMO) | Community First Health Plans, Inc. | T1 | No | $0 | TX |
| Community First Medicare Advantage D-SNP (HMO D-SNP) | Community First Health Plans, Inc. | T1 | No | $0 | TX |
| Community DualCare Aligned (HMO D-SNP) | Community Health Choice Texas, Inc. | T1 | No | $0 | TX |
| Community DualCare Access (HMO D-SNP) | Community Health Choice Texas, Inc. | T1 | No | $0 | TX |
| El Paso Health Medicare Advantage Dual (HMO D-SNP) | EL Paso First Health Plans, Inc. | T1 | No | $0 | TX |
| El Paso Health Total (HMO) | EL Paso First Health Plans, Inc. | T1 | No | $0 | TX |
| El Paso Health Giveback (HMO) | EL Paso First Health Plans, Inc. | T1 | No | $0 | TX |
| Liberty Medicare Advantage (HMO C-SNP) | Liberty Advantage, LLC | T1 | No | $0 | NC |
| Peak Advantage Vista (PPO) | Peak Health Insurance Corporation | T1 | No | $0 | PA, WV |
| SECUR Edge (HMO I-SNP) | Secur Inc | T1 | No | $0 | FL |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | No | $0 | AL |
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T1 | Yes | $0 | CA |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | Yes | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | Yes | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is dexmethylphenidate hydrochloride 5 MG Oral Tablet covered by Medicare Part D?
Yes, dexmethylphenidate hydrochloride 5 MG Oral Tablet is covered by 4,555 Medicare Part D plans (90.2% of all Part D formularies).
What tier is dexmethylphenidate hydrochloride 5 MG Oral Tablet on Medicare Part D plans?
dexmethylphenidate hydrochloride 5 MG Oral Tablet averages Tier 2.4 across Part D plans, ranging from Tier 1 to Tier 4.
Does dexmethylphenidate hydrochloride 5 MG Oral Tablet require prior authorization?
39.1% of Part D formularies require prior authorization for dexmethylphenidate hydrochloride 5 MG Oral Tablet. Step therapy: 0%. Quantity limits: 79.7%.
How much does Medicare spend on dexmethylphenidate hydrochloride 5 MG Oral Tablet?
In 2023, total Medicare Part D spending on dexmethylphenidate hydrochloride 5 MG Oral Tablet was $6,100,623, covering 9,197 beneficiaries. The average spend per beneficiary was $663.33.
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
- 10 ML furosemide 10 MG/ML Injection T2.4
- disulfiram 250 MG Oral Tablet T2.4
- hydrocortisone 10 MG/ML / neomycin 3.5 MG/ML / polymyxin B 10000 UNT/ML Otic Solution T2.4
- hydrochlorothiazide 12.5 MG / valsartan 320 MG Oral Tablet T2.4
- 168 HR ethinyl estradiol 0.00146 MG/HR / norelgestromin 0.00625 MG/HR Transdermal System [Xulane] T2.4
- amlodipine 5 MG / hydrochlorothiazide 12.5 MG / olmesartan medoxomil 20 MG Oral Tablet T2.4
Similar prior-authorization rate
- tiopronin 100 MG Oral Tablet 39.4% PA
- perampanel 0.5 MG/ML Oral Suspension 39.5% PA
- {2 (24 HR levomilnacipran 20 MG Extended Release Oral Capsule [Fetzima]) / 26 (24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima]) } Pack [Fetzima Pack] 38.7% PA
- 24 HR levomilnacipran 120 MG Extended Release Oral Capsule [Fetzima] 38.7% PA
- perampanel 4 MG Oral Tablet 39.6% PA
- perampanel 2 MG Oral Tablet 39.6% PA