Medicare Part D coverage · dichlorphenamide · RxCUI 197594
dichlorphenamide 50 MG Oral Tablet
Per the CMS 2026 Part D formulary file, dichlorphenamide 50 MG Oral Tablet is covered by 134 Medicare Part D plans (2.7% of enrollable products), averaging Tier 4.1, with prior authorization required on 96.4% of covering formularies.
- 2.7%
- Plan coverage
- 134
- Plans covering
- T4.1
- Avg tier
- 96.4%
- Prior auth required
What the CMS Formulary Data Shows for dichlorphenamide 50 MG Oral Tablet
Per the CMS 2026 Part D formulary file, dichlorphenamide 50 MG Oral Tablet (RxNorm concept RXCUI 197594, generic name dichlorphenamide) appears on 28 distinct formulary files spanning 134 Medicare Part D plan offerings - 2.7% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.1.
Real-world access to dichlorphenamide 50 MG Oral Tablet depends on utilization management as much as tier placement: 96.4% of covering formularies require prior authorization. 0% require step therapy. 53.6% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 98 Part D beneficiaries filled dichlorphenamide 50 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $20,667,743 and an average per-beneficiary annual cost of $210,895.34. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry dichlorphenamide 50 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 28
- Plans covering
- 134
- Coverage rate
- 2.7%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 96.4% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 53.6% of formularies
2023 Medicare Spending
- Beneficiaries
- 98
- Total spending
- $20,667,743
- Avg per beneficiary
- $210,895.34
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering dichlorphenamide 50 MG Oral Tablet
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T1 | Yes | $0 | CA |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | Yes | $0 | CA |
| 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 | Yes | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | Yes | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | Yes | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | Yes | $0 | MA |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | Selecthealth, Inc. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | UT |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | NV |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | CO |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | CO |
| Select Health Medicare Flex (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | CO |
Show the next 30 plans
| Select Health Medicare Active (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | Selecthealth, Inc. | T5 | Yes | $0 | NV |
| Select Health Medicare Wellness (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | NV |
| Medicare BlueEssential (PPO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Medicare BlueActive (PPO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Medicare BlueVital (PPO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Univera SeniorChoice Basic (HMO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Univera SeniorChoice Extra (HMO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Medicare Blue Choice Core (HMO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Univera Medicare Dual (HMO D-SNP) | Excellus Health Plan Community Care LLC | T5 | Yes | $0 | NY |
| Medicare Blue Dual (HMO D-SNP) | Excellus Health Plan Community Care LLC | T5 | Yes | $0 | NY |
| Network Health Select (PPO) | Network Health Insurance Corporation | T5 | Yes | $0 | WI |
| Network Health Go (PPO) | Network Health Insurance Corporation | T5 | Yes | $0 | WI |
| Network Health Anywhere (PPO) | Network Health Insurance Corporation | T5 | Yes | $0 | WI |
| Network Health Choice (PPO) | Network Health Insurance Corporation | T5 | Yes | $0 | WI |
| Network Health Zero (PPO) | Network Health Insurance Corporation | T5 | Yes | $0 | WI |
| Fallon Medicare Plus Orange (HMO) | Fallon Community Health Plan | T5 | Yes | $0 | MA |
| UPMC for Life HMO Premier Rx (HMO) | Upmc Health Plan, Inc. | T5 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | Upmc FOR YOU, Inc | T5 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | Upmc FOR YOU, Inc | T5 | Yes | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | Upmc Health Network, Inc. | T5 | Yes | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | Upmc Health Network, Inc. | T5 | Yes | $0 | PA |
| UPMC for Life PPO Essential Care Rx (PPO) | Upmc Health Network, Inc. | T5 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | Upmc Health Coverage, Inc. | T5 | Yes | $0 | PA |
| Healthy Mississippi Premier Advantage (HMO-POS) | Healthy Mississippi, Inc. | T5 | Yes | $0 | MS |
| PriorityMedicare Key (HMO-POS) | Priority Health | T5 | Yes | $0 | MI |
| PriorityMedicare Smart Savings (HMO-POS) | Priority Health | T5 | Yes | $0 | MI |
| PriorityMedicare Edge (PPO) | Priority Health | T5 | Yes | $0 | MI |
| PriorityMedicare Vital (PPO) | Priority Health | T5 | Yes | $0 | MI |
| PriorityMedicare Thrive (PPO) | Priority Health | T5 | Yes | $0 | MI |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is dichlorphenamide 50 MG Oral Tablet covered by Medicare Part D?
Yes, dichlorphenamide 50 MG Oral Tablet is covered by 134 Medicare Part D plans (2.7% of all Part D formularies).
What tier is dichlorphenamide 50 MG Oral Tablet on Medicare Part D plans?
dichlorphenamide 50 MG Oral Tablet averages Tier 4.1 across Part D plans, ranging from Tier 1 to Tier 5.
Does dichlorphenamide 50 MG Oral Tablet require prior authorization?
96.4% of Part D formularies require prior authorization for dichlorphenamide 50 MG Oral Tablet. Step therapy: 0%. Quantity limits: 53.6%.
How much does Medicare spend on dichlorphenamide 50 MG Oral Tablet?
In 2023, total Medicare Part D spending on dichlorphenamide 50 MG Oral Tablet was $20,667,743, covering 98 beneficiaries. The average spend per beneficiary was $210,895.34.
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
- brivaracetam 10 MG Oral Tablet [Briviact] T4.1
- rifaximin 550 MG Oral Tablet [XIFAXAN] T4.1
- tenofovir disoproxil fumarate 200 MG Oral Tablet [Viread] T4.1
- pomalidomide 1 MG Oral Capsule T4.1
- 1 ML benralizumab 30 MG/ML Prefilled Syringe [Fasenra] T4.1
- deferasirox 250 MG Tablet for Oral Suspension T4.1
Similar prior-authorization rate
- amifampridine 10 MG Oral Tablet [Firdapse] 96.4% PA
- {28 (elagolix 300 MG / estradiol 1 MG / norethindrone 0.5 MG Oral Capsule) / 28 (elagolix 300 MG Oral Capsule) } Pack [Oriahnn 28 Day Kit] 96.4% PA
- armodafinil 250 MG Oral Tablet 96.5% PA
- armodafinil 150 MG Oral Tablet 96.5% PA
- 1 ML darbepoetin alfa 0.2 MG/ML Injection [Aranesp] 96.5% PA
- 1 ML darbepoetin alfa 0.1 MG/ML Injection [Aranesp] 96.5% PA