eslicarbazepine acetate 200 MG Oral Tablet [Aptiom]
eslicarbazepine acetate
RxCUI: 1482513
What the CMS Formulary Data Shows for eslicarbazepine acetate 200 MG Oral Tablet [Aptiom]
Per the CMS 2026 Part D formulary file, eslicarbazepine acetate 200 MG Oral Tablet [Aptiom] (RxNorm concept RXCUI 1482513, generic name eslicarbazepine acetate) appears on 68 distinct formulary files spanning 1,405 Medicare Part D plan offerings - 27.7% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.2.
Real-world access to eslicarbazepine acetate 200 MG Oral Tablet [Aptiom] depends on utilization management as much as tier placement: 1.5% of covering formularies require prior authorization. 1.5% require step therapy. 95.6% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 8,348 Part D beneficiaries filled eslicarbazepine acetate 200 MG Oral Tablet [Aptiom] in 2023, with total plan-and-beneficiary spending of $142,014,028 and an average per-beneficiary annual cost of $17,011.74. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry eslicarbazepine acetate 200 MG Oral Tablet [Aptiom] today.
Coverage Details
- Formularies covering
- 68
- Plans covering
- 1,405
- Coverage rate
- 27.7%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 1.5% of formularies
- Step therapy required
- 1.5% of formularies
- Quantity limits
- 95.6% of formularies
2023 Medicare Spending
- Beneficiaries
- 8,348
- Total spending
- $142,014,028
- Avg per beneficiary
- $17,011.74
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering eslicarbazepine acetate 200 MG Oral Tablet [Aptiom]
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue MedicareRx Value Plus (PDP) | ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT | T4 | No | No | $20.70 | - |
| BlueMedicare Value Rx (PDP) | USABLE MUTUAL INSURANCE COMPANY | T4 | No | No | $52.50 | - |
Medicare Advantage Plans (MA-PD) Covering eslicarbazepine acetate 200 MG Oral Tablet [Aptiom]
98 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | HPMP OF FLORIDA, INC. | T1 | No | $0 | FL |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | ELDERPLAN, INC. | T1 | No | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | HEALTH CHOICE ARIZONA, INC. | T1 | No | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | HEALTHFIRST HEALTH PLAN, INC. | T1 | No | $0 | NY |
| IMCare Classic (HMO D-SNP) | ITASCA MEDICAL CARE | T1 | No | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | HOPKINS HEALTH ADVANTAGE, INC. | T1 | No | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | METROPLUS HEALTH PLAN, INC. | T1 | No | $0 | NY |
| Senior Whole Health SCO (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| Molina One Care (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| CCA One Care (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | T1 | No | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | T1 | No | $0 | MA |
| Florida Complete Care (HMO I-SNP) | HPMP OF FLORIDA, INC. | T1 | No | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | HPMP OF FLORIDA, INC. | T1 | No | $4.80 | FL |
| Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) | ELDERPLAN, INC. | T1 | No | $22.70 | NY |
| VIVA Medicare Extra Value (HMO D-SNP) | VIVA HEALTH, INC. | T1 | No | $27.70 | AL |
| VIVA Medicare Extra Care (HMO D-SNP) | VIVA HEALTH, INC. | T1 | No | $27.70 | AL |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $34.50 | NY |
| Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) | ELDERPLAN, INC. | T1 | No | $44.80 | NY |
| MetroPlus Platinum Plan (HMO) | METROPLUS HEALTH PLAN, INC. | T1 | No | $58.80 | NY |
| Medicare BlueEssential (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Medicare BlueActive (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Medicare BlueVital (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Univera SeniorChoice Basic (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Univera SeniorChoice Extra (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Medicare Blue Choice Core (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Univera Medicare Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T4 | No | $0 | NY |
| Medicare Blue Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T4 | No | $0 | NY |
| CDPHP $0 Medicare Rx (HMO) | CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Univera SeniorChoice Core (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $33.00 | NY |
| Univera SeniorChoice Advanced (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $36.90 | NY |
| Medicare BlueClassic (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $51.00 | NY |
| Univera SeniorChoice Secure (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $54.90 | NY |
| Medicare BlueBalanced (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $55.00 | NY |
| Medicare Blue Choice Prime (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $55.00 | NY |
| Univera SeniorChoice Value Plus (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $58.60 | NY |
| Medicare BlueEnhanced (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $70.30 | NY |
| Medicare BluePlus (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $86.40 | NY |
| CDPHP Clear Rx (HMO) | CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | T4 | No | $100.00 | NY |
| CDPHP Choice Rx (HMO) | CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | T4 | No | $135.00 | NY |
| Medicare Blue Choice Optimum (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $146.00 | NY |
| Aetna Medicare Signature (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T5 | No | $0 | CA |
| Aetna Medicare Signature (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T5 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T5 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T5 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T5 | No | $0 | CA |
Frequently Asked Questions
Is eslicarbazepine acetate 200 MG Oral Tablet [Aptiom] covered by Medicare Part D?
Yes, eslicarbazepine acetate 200 MG Oral Tablet [Aptiom] is covered by 1,405 Medicare Part D plans (27.7% of all Part D formularies).
What tier is eslicarbazepine acetate 200 MG Oral Tablet [Aptiom] on Medicare Part D plans?
eslicarbazepine acetate 200 MG Oral Tablet [Aptiom] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 5.
Does eslicarbazepine acetate 200 MG Oral Tablet [Aptiom] require prior authorization?
1.5% of Part D formularies require prior authorization for eslicarbazepine acetate 200 MG Oral Tablet [Aptiom]. Step therapy: 1.5%. Quantity limits: 95.6%.
How much does Medicare spend on eslicarbazepine acetate 200 MG Oral Tablet [Aptiom]?
In 2023, total Medicare Part D spending on eslicarbazepine acetate 200 MG Oral Tablet [Aptiom] was $142,014,028, covering 8,348 beneficiaries. The average spend per beneficiary was $17,011.74.
Read our methodology - how this data is sourced, computed, and verified.