dipyridamole 25 MG Oral Tablet
dipyridamole
RxCUI: 309952
What the CMS Formulary Data Shows for dipyridamole 25 MG Oral Tablet
Per the CMS 2026 Part D formulary file, dipyridamole 25 MG Oral Tablet (RxNorm concept RXCUI 309952, generic name dipyridamole) appears on 245 distinct formulary files spanning 2,805 Medicare Part D plan offerings - 55.4% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.5.
Real-world access to dipyridamole 25 MG Oral Tablet depends on utilization management as much as tier placement: 42% 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 3,216 Part D beneficiaries filled dipyridamole 25 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $1,829,673 and an average per-beneficiary annual cost of $568.93. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry dipyridamole 25 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 245
- Plans covering
- 2,805
- Coverage rate
- 55.4%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 42% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 3,216
- Total spending
- $1,829,673
- Avg per beneficiary
- $568.93
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering dipyridamole 25 MG Oral Tablet
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | SENTARA HEALTH PLANS | T1 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | SENTARA HEALTH PLANS | T1 | No | $0 | VA |
| HealthSun HealthAdvantage Plan (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun MediMax (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun MediSun Plus (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun MediSun Extra (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun MediSun Full Dual Plus (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| HealthSun MediSun Full Dual Extra (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Extra (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply More Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Complete Platinum (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply More Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Complete Platinum (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | Yes | $0 | FL |
Frequently Asked Questions
Is dipyridamole 25 MG Oral Tablet covered by Medicare Part D?
Yes, dipyridamole 25 MG Oral Tablet is covered by 2,805 Medicare Part D plans (55.4% of all Part D formularies).
What tier is dipyridamole 25 MG Oral Tablet on Medicare Part D plans?
dipyridamole 25 MG Oral Tablet averages Tier 2.5 across Part D plans, ranging from Tier 1 to Tier 4.
Does dipyridamole 25 MG Oral Tablet require prior authorization?
42% of Part D formularies require prior authorization for dipyridamole 25 MG Oral Tablet. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on dipyridamole 25 MG Oral Tablet?
In 2023, total Medicare Part D spending on dipyridamole 25 MG Oral Tablet was $1,829,673, covering 3,216 beneficiaries. The average spend per beneficiary was $568.93.
Read our methodology - how this data is sourced, computed, and verified.