Medicare Part D coverage · metformin hydrochloride · RxCUI 861021

metformin hydrochloride 625 MG Oral Tablet

Per the CMS 2026 Part D formulary file, metformin hydrochloride 625 MG Oral Tablet is covered by 5 Medicare Part D plans (0.1% of enrollable products), averaging Tier 1, with prior authorization required on 0% of covering formularies.

0.1%
Plan coverage
5
Plans covering
T1
Avg tier
0%
Prior auth required

Verify with CMS →

Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.

What the CMS Formulary Data Shows for metformin hydrochloride 625 MG Oral Tablet

Per the CMS 2026 Part D formulary file, metformin hydrochloride 625 MG Oral Tablet (RxNorm concept RXCUI 861021, generic name metformin hydrochloride) appears on 2 distinct formulary files spanning 5 Medicare Part D plan offerings - 0.1% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 1, with a cross-plan average of Tier 1.

Real-world access to metformin hydrochloride 625 MG Oral Tablet depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 50% apply quantity limits.

Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 5,918,026 Part D beneficiaries filled metformin hydrochloride 625 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $247,530,899 and an average per-beneficiary annual cost of $41.83. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry metformin hydrochloride 625 MG Oral Tablet today.

Coverage Details

Formularies covering
2
Plans covering
5
Coverage rate
0.1%
Tier range
Tier 1, Preferred Generic
Average tier
Tier 1, Preferred Generic

Restrictions

Prior authorization required
0% of formularies
Step therapy required
0% of formularies
Quantity limits
50% of formularies

2023 Medicare Spending

Beneficiaries
5,918,026
Total spending
$247,530,899
Avg per beneficiary
$41.83

Tier Distribution Across Plans

5 plans
Tier 1, Preferred Generic

Medicare Advantage Plans (MA-PD) Covering metformin hydrochloride 625 MG Oral Tablet

5 Medicare Advantage plans with Part D drug coverage include this drug.

Plan Insurer Tier PA Premium States
Community Care's Partnership Program (HMO D-SNP) Community Care Health Plan, Inc. T1 No $0 WI
Aspire Health Protect (HMO) Aspire Health Plan T1 No $0 CA
Aspire Health Value (HMO) Aspire Health Plan T1 No $22.60 CA
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

Frequently Asked Questions

Is metformin hydrochloride 625 MG Oral Tablet covered by Medicare Part D?

Yes, metformin hydrochloride 625 MG Oral Tablet is covered by 5 Medicare Part D plans (0.1% of all Part D formularies).

What tier is metformin hydrochloride 625 MG Oral Tablet on Medicare Part D plans?

metformin hydrochloride 625 MG Oral Tablet averages Tier 1 across Part D plans, ranging from Tier 1 to Tier 1.

Does metformin hydrochloride 625 MG Oral Tablet require prior authorization?

0% of Part D formularies require prior authorization for metformin hydrochloride 625 MG Oral Tablet. Step therapy: 0%. Quantity limits: 50%.

How much does Medicare spend on metformin hydrochloride 625 MG Oral Tablet?

In 2023, total Medicare Part D spending on metformin hydrochloride 625 MG Oral Tablet was $247,530,899, covering 5,918,026 beneficiaries. The average spend per beneficiary was $41.83.

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

Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare