dicyclomine hydrochloride 40 MG Oral Tablet

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dicyclomine hydrochloride

RxCUI: 2719470

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.
2.5%
Plan Coverage
129
Plans Covering
T3.8
Avg Tier
0%
Prior Auth Required

What the CMS Formulary Data Shows for dicyclomine hydrochloride 40 MG Oral Tablet

Per the CMS 2026 Part D formulary file, dicyclomine hydrochloride 40 MG Oral Tablet (RxNorm concept RXCUI 2719470, generic name dicyclomine hydrochloride) appears on 4 distinct formulary files spanning 129 Medicare Part D plan offerings - 2.5% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 2 to Tier 5, with a cross-plan average of Tier 3.8.

Real-world access to dicyclomine hydrochloride 40 MG Oral Tablet 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 887,927 Part D beneficiaries filled dicyclomine hydrochloride 40 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $53,400,015 and an average per-beneficiary annual cost of $60.14. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry dicyclomine hydrochloride 40 MG Oral Tablet today.

Coverage Details

Formularies covering
4
Plans covering
129
Coverage rate
2.5%
Tier range
Tier 2 – Tier 5
Average tier
Tier 4, Non-Preferred

Restrictions

Prior authorization required
0% of formularies
Step therapy required
0% of formularies
Quantity limits
0% of formularies

2023 Medicare Spending

Beneficiaries
887,927
Total spending
$53,400,015
Avg per beneficiary
$60.14

Tier Distribution Across Plans

4 plans
Tier 2, Generic
10 plans
Tier 3, Preferred Brand
86 plans
Tier 5, Specialty

Medicare Advantage Plans (MA-PD) Covering dicyclomine hydrochloride 40 MG Oral Tablet

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

Plan Insurer Tier PA Premium States
Health New England Medicare Compass (PPO) HEALTH NEW ENGLAND, INC. T2 No $0 MA
Health New England Medicare Value (HMO) HEALTH NEW ENGLAND, INC. T2 No $0 MA
Health New England Medicare Premium (HMO) HEALTH NEW ENGLAND, INC. T2 No $15.80 MA
Health New England Medicare Plus (HMO) HEALTH NEW ENGLAND, INC. T2 No $58.40 MA
Health First Rewards H1099-014 (HMO) HEALTH FIRST HEALTH PLANS T3 No $0 FL
Health First SunSaver H1099-016 (HMO) HEALTH FIRST HEALTH PLANS T3 No $0 FL
Health First Complete Care H1099-023 (HMO) HEALTH FIRST HEALTH PLANS T3 No $0 FL
Health First Emerald Plus H1099-024 (HMO) HEALTH FIRST HEALTH PLANS T3 No $0 FL
Health First Premier Access H1099-025 (HMO-POS) HEALTH FIRST HEALTH PLANS T3 No $0 FL
Health First Emerald Plus H1099-026 (HMO) HEALTH FIRST HEALTH PLANS T3 No $0 FL
Health First Premier Access H1099-027 (HMO-POS) HEALTH FIRST HEALTH PLANS T3 No $0 FL
Health First Emerald Plus H1099-028 (HMO) HEALTH FIRST HEALTH PLANS T3 No $0 FL
Health First Value H1099-006 (HMO) HEALTH FIRST HEALTH PLANS T3 No $15.00 FL
Health First Classic H1099-001 (HMO-POS) HEALTH FIRST HEALTH PLANS T3 No $49.40 FL
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Solano (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Inland Empire (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Ventura (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Kern (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic Kern (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage San Diego (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic Stanis (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic Fresno (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Santa Cruz (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic Alameda (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic SF (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic Solano (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Sr Advantage Inland Empire Value (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage San Diego Value (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Ventura Value (HMO) KAISER FOUNDATION HP, INC. T5 No $0 CA
Kaiser Permanente Senior Advantage Core DM (HMO) KAISER FOUNDATION HP OF CO T5 No $0 CO
Kaiser Permanente Dual Essential (HMO D-SNP) KAISER FOUNDATION HP OF CO T5 No $0 CO
Kaiser Permanente Senior Advantage Silver DM (HMO-POS) KAISER FOUNDATION HP OF CO T5 No $0 CO
Kaiser Permanente Senior Advantage Core South (HMO) KAISER FOUNDATION HP OF CO T5 No $0 CO
Kaiser Permanente Senior Advantage Core North (HMO) KAISER FOUNDATION HP OF CO T5 No $0 CO
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) KAISER FOUNDATION HP OF CO T5 No $0 CO
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) KAISER FOUNDATION HP OF CO T5 No $0 CO
Kaiser Permanente Senior Advantage Bronze DM (HMO-POS) KAISER FOUNDATION HP OF CO T5 No $0 CO
Kaiser Permanente Dual Complete (HMO D-SNP) KAISER FOUNDATION HP OF CO T5 No $0 CO
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) KAISER FOUNDATION HP OF GA, INC. T5 No $0 GA
Kaiser Permanente Senior Advantage Basic 1 (HMO) KAISER FOUNDATION HP OF GA, INC. T5 No $0 GA

Frequently Asked Questions

Is dicyclomine hydrochloride 40 MG Oral Tablet covered by Medicare Part D?

Yes, dicyclomine hydrochloride 40 MG Oral Tablet is covered by 129 Medicare Part D plans (2.5% of all Part D formularies).

What tier is dicyclomine hydrochloride 40 MG Oral Tablet on Medicare Part D plans?

dicyclomine hydrochloride 40 MG Oral Tablet averages Tier 3.8 across Part D plans, ranging from Tier 2 to Tier 5.

Does dicyclomine hydrochloride 40 MG Oral Tablet require prior authorization?

0% of Part D formularies require prior authorization for dicyclomine hydrochloride 40 MG Oral Tablet. Step therapy: 0%. Quantity limits: 0%.

How much does Medicare spend on dicyclomine hydrochloride 40 MG Oral Tablet?

In 2023, total Medicare Part D spending on dicyclomine hydrochloride 40 MG Oral Tablet was $53,400,015, covering 887,927 beneficiaries. The average spend per beneficiary was $60.14.

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