Medicare Part D coverage · escitalopram · RxCUI 2725159
escitalopram 15 MG Oral Capsule
Per the CMS 2026 Part D formulary file, escitalopram 15 MG Oral Capsule is covered by 1,721 Medicare Part D plans (34.1% of enrollable products), averaging Tier 3.6, with prior authorization required on 29% of covering formularies.
- 34.1%
- Plan coverage
- 1,721
- Plans covering
- T3.6
- Avg tier
- 29%
- Prior auth required
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 1,721 Medicare Part D plan offerings - 34.1% 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
- 1,721
- Coverage rate
- 34.1%
- 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 |
Show the next 30 plans
| 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 |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is escitalopram 15 MG Oral Capsule covered by Medicare Part D?
Yes, escitalopram 15 MG Oral Capsule is covered by 1,721 Medicare Part D plans (34.1% 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.
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
- lomustine 40 MG Oral Capsule [Gleostine] T3.6
- isotretinoin 35 MG Oral Capsule T3.6
- clindamycin 10 MG/ML Topical Foam [Clindacin] T3.6
- 90 DAY estradiol 0.000313 MG/HR Vaginal System [Estring] T3.5
- estradiol cypionate 5 MG/ML Injectable Solution [Depo-estradiol] T3.5
- bromocriptine 0.8 MG Oral Tablet [Cycloset] T3.5
Similar prior-authorization rate
- doxepin 10 MG Oral Capsule 29% PA
- doxepin 100 MG Oral Capsule 29% PA
- doxepin 150 MG Oral Capsule 29% PA
- doxepin 10 MG/ML Oral Solution 29% PA
- temazepam 15 MG Oral Capsule 29.2% PA
- roflumilast 0.5 MG Oral Tablet 29.3% PA