Medicare Part D coverage · methadone hydrochloride · RxCUI 864718
methadone hydrochloride 5 MG Oral Tablet
Per the CMS 2026 Part D formulary file, methadone hydrochloride 5 MG Oral Tablet is covered by 5,027 Medicare Part D plans (99.5% of enrollable products), averaging Tier 2.2, with prior authorization required on 34.9% of covering formularies.
- 99.5%
- Plan coverage
- 5,027
- Plans covering
- T2.2
- Avg tier
- 34.9%
- Prior auth required
What the CMS Formulary Data Shows for methadone hydrochloride 5 MG Oral Tablet
Per the CMS 2026 Part D formulary file, methadone hydrochloride 5 MG Oral Tablet (RxNorm concept RXCUI 864718, generic name methadone hydrochloride) appears on 324 distinct formulary files spanning 5,027 Medicare Part D plan offerings - 99.5% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.2.
Real-world access to methadone hydrochloride 5 MG Oral Tablet depends on utilization management as much as tier placement: 34.9% of covering formularies require prior authorization. 0% require step therapy. 89.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 68,081 Part D beneficiaries filled methadone hydrochloride 5 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $13,167,959 and an average per-beneficiary annual cost of $193.42. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry methadone hydrochloride 5 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 324
- Plans covering
- 5,027
- Coverage rate
- 99.5%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 34.9% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 89.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 68,081
- Total spending
- $13,167,959
- Avg per beneficiary
- $193.42
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering methadone hydrochloride 5 MG Oral Tablet
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | Yes | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | Yes | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | Yes | $0 | NJ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | Yes | $0 | NY |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | Yes | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | Yes | $0 | GA |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
Show the next 30 plans
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | Yes | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | No | $0 | GA |
| KeyCare Advantage Plus (HMO C-SNP) | Isnp Ventures, LLC | T1 | No | $0 | MD |
| Premier Care (HMO-POS I-SNP) | Lifeworks Advantage, LLC | T1 | No | $0 | VA |
| Premier Care (HMO I-SNP) | Align Senior Care California Inc. | T1 | No | $0 | CA |
| Advantage Care (HMO) | Align Senior Care California Inc. | T1 | No | $0 | CA |
| Premier Care (HMO-POS I-SNP) | Align Senior Care MI, LLC | T1 | No | $0 | MI |
| Premier Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | No | $0 | FL |
| Perennial Advantage Freedom (HMO-POS) | Perennial Advantage OF Colorado, Inc. | T1 | No | $0 | CO |
| Perennial Advantage Premier (HMO-POS I-SNP) | Perennial Advantage OF Colorado, Inc. | T1 | No | $0 | CO |
| Perennial Advantage Freedom (HMO) | Perennial Advantage OF Colorado, Inc. | T1 | No | $0 | PA |
| Perennial Advantage Premier (HMO I-SNP) | Perennial Advantage OF Colorado, Inc. | T1 | No | $0 | PA |
| Perennial Advantage Freedom (HMO-POS) | Perennial Advantage OF Ohio, Inc. | T1 | No | $0 | OH |
| Perennial Advantage Premier (HMO-POS I-SNP) | Perennial Advantage OF Ohio, Inc. | T1 | No | $0 | OH |
| ProCare Advantage - Diabetes Care Management (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | No | $0 | TX |
| PruittHealth Premier Advantage (HMO I-SNP) | Pruitthealth Premier, Inc. | T1 | No | $0 | GA |
| Senior Health Plan Silver Plus (HMO) | Communitycare Government Programs, Inc. | T1 | No | $0 | OK |
| Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) | Communitycare Government Programs, Inc. | T1 | No | $0 | OK |
| Community First Medicare Advantage Alamo Plan (HMO) | Community First Health Plans, Inc. | T1 | No | $0 | TX |
| Community First Medicare Advantage D-SNP (HMO D-SNP) | Community First Health Plans, Inc. | T1 | No | $0 | TX |
| Community DualCare Aligned (HMO D-SNP) | Community Health Choice Texas, Inc. | T1 | No | $0 | TX |
| Community DualCare Access (HMO D-SNP) | Community Health Choice Texas, Inc. | T1 | No | $0 | TX |
| El Paso Health Medicare Advantage Dual (HMO D-SNP) | EL Paso First Health Plans, Inc. | T1 | No | $0 | TX |
| El Paso Health Total (HMO) | EL Paso First Health Plans, Inc. | T1 | No | $0 | TX |
| El Paso Health Giveback (HMO) | EL Paso First Health Plans, Inc. | T1 | No | $0 | TX |
| Liberty Medicare Advantage (HMO C-SNP) | Liberty Advantage, LLC | T1 | No | $0 | NC |
| Peak Advantage Vista (PPO) | Peak Health Insurance Corporation | T1 | No | $0 | PA, WV |
| SECUR Edge (HMO I-SNP) | Secur Inc | T1 | No | $0 | FL |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | No | $0 | AL |
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T1 | No | $0 | CA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is methadone hydrochloride 5 MG Oral Tablet covered by Medicare Part D?
Yes, methadone hydrochloride 5 MG Oral Tablet is covered by 5,027 Medicare Part D plans (99.5% of all Part D formularies).
What tier is methadone hydrochloride 5 MG Oral Tablet on Medicare Part D plans?
methadone hydrochloride 5 MG Oral Tablet averages Tier 2.2 across Part D plans, ranging from Tier 1 to Tier 4.
Does methadone hydrochloride 5 MG Oral Tablet require prior authorization?
34.9% of Part D formularies require prior authorization for methadone hydrochloride 5 MG Oral Tablet. Step therapy: 0%. Quantity limits: 89.5%.
How much does Medicare spend on methadone hydrochloride 5 MG Oral Tablet?
In 2023, total Medicare Part D spending on methadone hydrochloride 5 MG Oral Tablet was $13,167,959, covering 68,081 beneficiaries. The average spend per beneficiary was $193.42.
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
- 0.5 ML meningococcal group B vaccine 0.1 MG/ML / Neisseria meningitidis serogroup B recombinant FHBP fusion protein antigen 0.1 MG/ML / Neisseria meningitidis serogroup B recombinant NHBA fusion protein antigen 0.1 MG/ML / Neisseria meningitidis serogroup B strain NZ98/254 outer membrane vesicle 0.05 MG/ML Prefilled Syringe [Bexsero] T2.2
- BCG, live, Tice strain 50 MG Injection T2.2
- glimepiride 1 MG Oral Tablet T2.2
- megestrol acetate 40 MG Oral Tablet T2.2
- permethrin 50 MG/ML Topical Cream T2.2
- poliovirus vaccine inactivated, type 1 (Mahoney) 80 UNT/ML / poliovirus vaccine inactivated, type 2 (MEF-1) 16 UNT/ML / poliovirus vaccine inactivated, type 3 (Saukett) 64 UNT/ML Injectable Suspension [Ipol] T2.2
Similar prior-authorization rate
- 168 HR buprenorphine 0.01 MG/HR Transdermal System 34.8% PA
- atovaquone 150 MG/ML Oral Suspension 34.5% PA
- promethazine hydrochloride 25 MG Rectal Suppository [Promethegan] 35.4% PA
- methylphenidate hydrochloride 1 MG/ML Oral Solution 34.3% PA
- isotretinoin 30 MG Oral Capsule [Zenatane] 35.9% PA
- isotretinoin 10 MG Oral Capsule [Zenatane] 35.9% PA