escitalopram 15 MG Oral Capsule
escitalopram
RxCUI: 2725159
What the CMS Formulary Data Shows for escitalopram 15 MG Oral Capsule
Per the CMS 2026 Part D formulary file, escitalopram 15 MG Oral Capsule (RxNorm concept RXCUI 2725159, generic name escitalopram) appears on 31 distinct formulary files spanning 1,722 Medicare Part D plan offerings - 34% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 3.6.
Real-world access to escitalopram 15 MG Oral Capsule depends on utilization management as much as tier placement: 29% of covering formularies require prior authorization. 3.2% require step therapy. 58.1% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 2,538,742 Part D beneficiaries filled escitalopram 15 MG Oral Capsule in 2023, with total plan-and-beneficiary spending of $171,914,954 and an average per-beneficiary annual cost of $67.72. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry escitalopram 15 MG Oral Capsule today.
Coverage Details
- Formularies covering
- 31
- Plans covering
- 1,722
- Coverage rate
- 34%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 29% of formularies
- Step therapy required
- 3.2% of formularies
- Quantity limits
- 58.1% of formularies
2023 Medicare Spending
- Beneficiaries
- 2,538,742
- Total spending
- $171,914,954
- Avg per beneficiary
- $67.72
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering escitalopram 15 MG Oral Capsule
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK HEALTH OPTIONS WEST VIRGINIA INC. | T1 | No | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | No | $0 | DE |
| Leon MediExtra (HMO) | LEON HEALTH, INC. | T1 | No | $0 | FL |
| Leon MediDual (HMO D-SNP) | LEON HEALTH, INC. | T1 | No | $0 | FL |
| Leon MediMore (HMO) | LEON HEALTH, INC. | T1 | No | $0 | FL |
| Leon MediMax (HMO D-SNP) | LEON HEALTH, INC. | T1 | No | $0 | FL |
| Aspire Health Protect (HMO) | ASPIRE HEALTH PLAN | T1 | No | $0 | CA |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $13.10 | PA |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $17.60 | PA |
| Aspire Health Value (HMO) | ASPIRE HEALTH PLAN | T1 | No | $22.60 | CA |
| Highmark Health Options Duals Select (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | No | $31.20 | DE |
| Aspire Health Advantage (HMO) | ASPIRE HEALTH PLAN | T1 | No | $44.80 | CA |
| Aspire Health Plus (HMO-POS) | ASPIRE HEALTH PLAN | T1 | No | $119.20 | CA |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T2 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | UT |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | NV |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | CO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | CO |
| Select Health Medicare Flex (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | CO |
| Select Health Medicare Active (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T2 | No | $0 | NV |
| Select Health Medicare Wellness (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | NV |
| Healthy Mississippi Premier Advantage (HMO-POS) | Healthy Mississippi, Inc. | T2 | No | $0 | MS |
| MMM Supremo (HMO C-SNP) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Diamante Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Unico (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Elite (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Deluxe (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Dorado Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| PMC Premier Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| PMC Max (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Plenitud (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Valioso (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Combo Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Flexi Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Grandioso (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Mega Flex (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Relax Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Balance (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| Aetna Medicare Signature (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T4 | Yes | $0 | CA |
| Aetna Medicare Signature (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T4 | Yes | $0 | CA |
| Aetna Medicare Signature Extra (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T4 | Yes | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T4 | Yes | $0 | CA |
Frequently Asked Questions
Is escitalopram 15 MG Oral Capsule covered by Medicare Part D?
Yes, escitalopram 15 MG Oral Capsule is covered by 1,722 Medicare Part D plans (34% of all Part D formularies).
What tier is escitalopram 15 MG Oral Capsule on Medicare Part D plans?
escitalopram 15 MG Oral Capsule averages Tier 3.6 across Part D plans, ranging from Tier 1 to Tier 4.
Does escitalopram 15 MG Oral Capsule require prior authorization?
29% of Part D formularies require prior authorization for escitalopram 15 MG Oral Capsule. Step therapy: 3.2%. Quantity limits: 58.1%.
How much does Medicare spend on escitalopram 15 MG Oral Capsule?
In 2023, total Medicare Part D spending on escitalopram 15 MG Oral Capsule was $171,914,954, covering 2,538,742 beneficiaries. The average spend per beneficiary was $67.72.
Read our methodology - how this data is sourced, computed, and verified.