metformin hydrochloride 625 MG Oral Tablet

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metformin hydrochloride

RxCUI: 861021

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.
0.1%
Plan Coverage
5
Plans Covering
T1
Avg Tier
0%
Prior Auth Required

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 $247,531,906 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
$247,531,906
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 $247,531,906, covering 5,918,026 beneficiaries. The average spend per beneficiary was $41.83.

Read our methodology - how this data is sourced, computed, and verified.

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