Medicare Part D coverage · methylphenidate hydrochloride · RxCUI 1091392
methylphenidate hydrochloride 20 MG Oral Tablet
Per the CMS 2026 Part D formulary file, methylphenidate hydrochloride 20 MG Oral Tablet is covered by 5,052 Medicare Part D plans (100% of enrollable products), averaging Tier 2.1, with prior authorization required on 33.8% of covering formularies.
- 100%
- Plan coverage
- 5,052
- Plans covering
- T2.1
- Avg tier
- 33.8%
- Prior auth required
What the CMS Formulary Data Shows for methylphenidate hydrochloride 20 MG Oral Tablet
Per the CMS 2026 Part D formulary file, methylphenidate hydrochloride 20 MG Oral Tablet (RxNorm concept RXCUI 1091392, generic name methylphenidate hydrochloride) appears on 328 distinct formulary files spanning 5,052 Medicare Part D plan offerings - 100% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.1.
Real-world access to methylphenidate hydrochloride 20 MG Oral Tablet depends on utilization management as much as tier placement: 33.8% of covering formularies require prior authorization. 0% require step therapy. 79.3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 108,959 Part D beneficiaries filled methylphenidate hydrochloride 20 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $18,053,775 and an average per-beneficiary annual cost of $165.69. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry methylphenidate hydrochloride 20 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 328
- Plans covering
- 5,052
- Coverage rate
- 100%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 33.8% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 79.3% of formularies
2023 Medicare Spending
- Beneficiaries
- 108,959
- Total spending
- $18,053,775
- Avg per beneficiary
- $165.69
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering methylphenidate hydrochloride 20 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 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| Freedom VIP Care (HMO C-SNP) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | Yes | $0 | FL |
| Optimum Diamond Savings (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | Yes | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | Yes | $0 | FL |
| Optimum Diamond (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | Yes | $0 | FL |
| Freedom Medi-Medi Partial (HMO D-SNP) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom Medi-Medi Full (HMO D-SNP) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Optimum Emerald Partial (HMO D-SNP) | Optimum Healthcare, Inc. | T1 | Yes | $0 | FL |
| Optimum Emerald Full (HMO D-SNP) | Optimum Healthcare, Inc. | T1 | Yes | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
Show the next 30 plans
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom Máximo (HMO-POS) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Freedom Máximo (HMO-POS) | Freedom Health, Inc. | T1 | Yes | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | Optimum Healthcare, Inc. | T1 | Yes | $0 | FL |
| Optimum Platinum Plan (HMO) | Optimum Healthcare, Inc. | T1 | Yes | $0 | FL |
| Optimum Gold Plan (HMO) | Optimum Healthcare, Inc. | T1 | Yes | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | Optimum Healthcare, Inc. | T1 | Yes | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | Optimum Healthcare, Inc. | T1 | Yes | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | Yes | $0 | FL |
| Optimum Diamond Savings COPD (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | Yes | $0 | FL |
| Optimum Gold Plus Plan (HMO) | Optimum Healthcare, Inc. | T1 | Yes | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | Yes | $0 | FL |
| 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 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $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 |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is methylphenidate hydrochloride 20 MG Oral Tablet covered by Medicare Part D?
Yes, methylphenidate hydrochloride 20 MG Oral Tablet is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).
What tier is methylphenidate hydrochloride 20 MG Oral Tablet on Medicare Part D plans?
methylphenidate hydrochloride 20 MG Oral Tablet averages Tier 2.1 across Part D plans, ranging from Tier 1 to Tier 4.
Does methylphenidate hydrochloride 20 MG Oral Tablet require prior authorization?
33.8% of Part D formularies require prior authorization for methylphenidate hydrochloride 20 MG Oral Tablet. Step therapy: 0%. Quantity limits: 79.3%.
How much does Medicare spend on methylphenidate hydrochloride 20 MG Oral Tablet?
In 2023, total Medicare Part D spending on methylphenidate hydrochloride 20 MG Oral Tablet was $18,053,775, covering 108,959 beneficiaries. The average spend per beneficiary was $165.69.
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
- 24 HR divalproex sodium 250 MG Extended Release Oral Tablet T2.1
- carbamazepine 100 MG Chewable Tablet T2.1
- theophylline 400 MG Extended Release Oral Tablet T2.1
- 1 ML medroxyprogesterone acetate 150 MG/ML Prefilled Syringe T2.1
- silver sulfadiazine 10 MG/ML Topical Cream [SSD] T2.1
- azithromycin 20 MG/ML Oral Suspension T2.1
Similar prior-authorization rate
- 1 ML denosumab-bmwo 60 MG/ML Prefilled Syringe [Stoboclo] 33.8% PA
- acitretin 17.5 MG Oral Capsule 33.5% PA
- acitretin 10 MG Oral Capsule 33.5% PA
- methotrexate 25 MG/ML Injectable Solution 33.5% PA
- pretomanid 200 MG Oral Tablet 33.3% PA
- aspirin 325 MG / butalbital 50 MG / caffeine 40 MG / codeine phosphate 30 MG Oral Capsule [Ascomp] 33.3% PA