Medicare Part D coverage · nortriptyline · RxCUI 317136
nortriptyline 25 MG Oral Capsule
Per the CMS 2026 Part D formulary file, nortriptyline 25 MG Oral Capsule is covered by 5,052 Medicare Part D plans (100% of enrollable products), averaging Tier 1.7, with prior authorization required on 4% of covering formularies.
- 100%
- Plan coverage
- 5,052
- Plans covering
- T1.7
- Avg tier
- 4%
- Prior auth required
What the CMS Formulary Data Shows for nortriptyline 25 MG Oral Capsule
Per the CMS 2026 Part D formulary file, nortriptyline 25 MG Oral Capsule (RxNorm concept RXCUI 317136, generic name nortriptyline) 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 1.7.
Real-world access to nortriptyline 25 MG Oral Capsule depends on utilization management as much as tier placement: 4% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 302,986 Part D beneficiaries filled nortriptyline 25 MG Oral Capsule in 2023, with total plan-and-beneficiary spending of $23,070,730 and an average per-beneficiary annual cost of $76.14. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry nortriptyline 25 MG Oral Capsule 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
- 4% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 302,986
- Total spending
- $23,070,730
- Avg per beneficiary
- $76.14
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering nortriptyline 25 MG Oral Capsule
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 |
| Anthem Medicare Advantage (HMO-POS) | Blue Cross OF California | T1 | No | $0 | CA |
| Anthem Medicare Advantage (HMO-POS) | Blue Cross OF California | T1 | No | $0 | CA |
| Anthem Medicare Advantage (HMO-POS) | Blue Cross OF California | T1 | No | $0 | CA |
| Anthem Medicare Advantage (HMO-POS) | Blue Cross OF California | T1 | No | $0 | CA |
| Anthem Full Dual Advantage (HMO D-SNP) | Anthem Insurance Companies, Inc. | T1 | No | $0 | IN |
| Anthem I PathWays Dual Care Advantage (HMO D-SNP) | Anthem Insurance Companies, Inc. | T1 | No | $0 | IN |
| Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) | Anthem Insurance Companies, Inc. | T1 | No | $0 | IN |
| Wellpoint Full Dual Advantage (HMO-POS D-SNP) | Wellpoint Iowa, Inc. | T1 | No | $0 | IA |
| Wellpoint Full Dual Advantage 2 (HMO-POS D-SNP) | Wellpoint Iowa, Inc. | T1 | No | $0 | IA |
| Wellpoint Full Dual Advantage (HMO D-SNP) | Wellpoint West Virginia , Inc. | T1 | No | $0 | WV |
| Wellpoint Full Dual Advantage (HMO D-SNP) | Wellpoint Washington, Inc. | T1 | No | $0 | WA |
| Wellpoint Dual Advantage (HMO D-SNP) | Wellpoint Washington, Inc. | T1 | No | $0 | WA |
| Healthy Blue Dual Advantage (HMO D-SNP) | Community Care Health Plan OF Louisiana, Inc. | T1 | No | $0 | LA |
| Healthy Blue Dual Advantage 2 (HMO D-SNP) | Community Care Health Plan OF Louisiana, Inc. | T1 | No | $0 | LA |
| Anthem Dual Advantage (PPO D-SNP) | Anthem Insurance Companies, Inc. | T1 | No | $0 | VA |
| Wellpoint Medicare Advantage 2 (HMO-POS) | Wellpoint Texas, Inc. | T1 | No | $0 | TX |
| Wellpoint Kidney Care (HMO-POS C-SNP) | Wellpoint Texas, Inc. | T1 | No | $0 | TX |
| Wellpoint Dual Advantage 2 (HMO D-SNP) | Wellpoint Texas, Inc. | T1 | No | $0 | TX |
Show the next 30 plans
Showing top 50 of 100 plans.
Frequently Asked Questions
Is nortriptyline 25 MG Oral Capsule covered by Medicare Part D?
Yes, nortriptyline 25 MG Oral Capsule is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).
What tier is nortriptyline 25 MG Oral Capsule on Medicare Part D plans?
nortriptyline 25 MG Oral Capsule averages Tier 1.7 across Part D plans, ranging from Tier 1 to Tier 4.
Does nortriptyline 25 MG Oral Capsule require prior authorization?
4% of Part D formularies require prior authorization for nortriptyline 25 MG Oral Capsule. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on nortriptyline 25 MG Oral Capsule?
In 2023, total Medicare Part D spending on nortriptyline 25 MG Oral Capsule was $23,070,730, covering 302,986 beneficiaries. The average spend per beneficiary was $76.14.
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
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