Medicare Part D coverage · methylphenidate hydrochloride · RxCUI 1091497
methylphenidate hydrochloride 5 MG Oral Tablet
Per the CMS 2026 Part D formulary file, methylphenidate hydrochloride 5 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 5 MG Oral Tablet
Per the CMS 2026 Part D formulary file, methylphenidate hydrochloride 5 MG Oral Tablet (RxNorm concept RXCUI 1091497, 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 5 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 5 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 5 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 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 | 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 |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun MediMax (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun MediSun Plus (HMO D-SNP) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun MediSun Extra (HMO D-SNP) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T1 | Yes | $0 | FL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is methylphenidate hydrochloride 5 MG Oral Tablet covered by Medicare Part D?
Yes, methylphenidate hydrochloride 5 MG Oral Tablet is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).
What tier is methylphenidate hydrochloride 5 MG Oral Tablet on Medicare Part D plans?
methylphenidate hydrochloride 5 MG Oral Tablet averages Tier 2.1 across Part D plans, ranging from Tier 1 to Tier 4.
Does methylphenidate hydrochloride 5 MG Oral Tablet require prior authorization?
33.8% of Part D formularies require prior authorization for methylphenidate hydrochloride 5 MG Oral Tablet. Step therapy: 0%. Quantity limits: 79.3%.
How much does Medicare spend on methylphenidate hydrochloride 5 MG Oral Tablet?
In 2023, total Medicare Part D spending on methylphenidate hydrochloride 5 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