Medicare Part D coverage · duloxetine · RxCUI 596926
duloxetine 20 MG Delayed Release Oral Capsule
Per the CMS 2026 Part D formulary file, duloxetine 20 MG Delayed Release Oral Capsule is covered by 5,052 Medicare Part D plans (100% of enrollable products), averaging Tier 1.9, with prior authorization required on 0% of covering formularies.
- 100%
- Plan coverage
- 5,052
- Plans covering
- T1.9
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for duloxetine 20 MG Delayed Release Oral Capsule
Per the CMS 2026 Part D formulary file, duloxetine 20 MG Delayed Release Oral Capsule (RxNorm concept RXCUI 596926, generic name duloxetine) appears on 328 distinct formulary files spanning 5,052 Medicare Part D plan offerings - 100% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 1.9.
Real-world access to duloxetine 20 MG Delayed Release Oral Capsule depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 94.2% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 2,465,211 Part D beneficiaries filled duloxetine 20 MG Delayed Release Oral Capsule in 2023, with total plan-and-beneficiary spending of $398,776,169 and an average per-beneficiary annual cost of $161.76. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry duloxetine 20 MG Delayed Release Oral Capsule today.
Coverage Details
- Formularies covering
- 328
- Plans covering
- 5,052
- Coverage rate
- 100%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 94.2% of formularies
2023 Medicare Spending
- Beneficiaries
- 2,465,211
- Total spending
- $398,776,169
- Avg per beneficiary
- $161.76
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering duloxetine 20 MG Delayed Release Oral Capsule
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 |
| Freedom VIP Care (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Savings (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Freedom Medi-Medi Partial (HMO D-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Medi-Medi Full (HMO D-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Optimum Emerald Partial (HMO D-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Emerald Full (HMO D-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
Show the next 30 plans
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Máximo (HMO-POS) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Máximo (HMO-POS) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Platinum Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Gold Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Savings COPD (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Gold Plus Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | No | $0 | FL |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $0 | NJ |
| Providence Medicare Extra Part B Only + Rx (HMO) | Providence Health Assurance | T1 | No | $0 | OR |
| Providence Medicare Prime + Rx (HMO) | Providence Health Assurance | T1 | No | $0 | OR |
| Providence Medicare Dual Plus (HMO D-SNP) | Providence Health Assurance | T1 | No | $0 | OR |
| Providence Medicare Timber + Rx (HMO) | Providence Health Assurance | T1 | No | $0 | OR, WA |
| Providence Medicare Pine + Rx (HMO) | Providence Health Assurance | T1 | No | $0 | WA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is duloxetine 20 MG Delayed Release Oral Capsule covered by Medicare Part D?
Yes, duloxetine 20 MG Delayed Release Oral Capsule is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).
What tier is duloxetine 20 MG Delayed Release Oral Capsule on Medicare Part D plans?
duloxetine 20 MG Delayed Release Oral Capsule averages Tier 1.9 across Part D plans, ranging from Tier 1 to Tier 4.
Does duloxetine 20 MG Delayed Release Oral Capsule require prior authorization?
0% of Part D formularies require prior authorization for duloxetine 20 MG Delayed Release Oral Capsule. Step therapy: 0%. Quantity limits: 94.2%.
How much does Medicare spend on duloxetine 20 MG Delayed Release Oral Capsule?
In 2023, total Medicare Part D spending on duloxetine 20 MG Delayed Release Oral Capsule was $398,776,169, covering 2,465,211 beneficiaries. The average spend per beneficiary was $161.76.
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
Similar prior-authorization rate
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