olsalazine sodium 250 MG Oral Capsule [Dipentum]
olsalazine sodium
RxCUI: 905164
What the CMS Formulary Data Shows for olsalazine sodium 250 MG Oral Capsule [Dipentum]
Per the CMS 2026 Part D formulary file, olsalazine sodium 250 MG Oral Capsule [Dipentum] (RxNorm concept RXCUI 905164, generic name olsalazine sodium) appears on 24 distinct formulary files spanning 285 Medicare Part D plan offerings - 5.6% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 4.3.
Real-world access to olsalazine sodium 250 MG Oral Capsule [Dipentum] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 45.8% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 215 Part D beneficiaries filled olsalazine sodium 250 MG Oral Capsule [Dipentum] in 2023, with total plan-and-beneficiary spending of $2,854,712 and an average per-beneficiary annual cost of $13,277.73. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry olsalazine sodium 250 MG Oral Capsule [Dipentum] today.
Coverage Details
- Formularies covering
- 24
- Plans covering
- 285
- Coverage rate
- 5.6%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 45.8% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 215
- Total spending
- $2,854,712
- Avg per beneficiary
- $13,277.73
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering olsalazine sodium 250 MG Oral Capsule [Dipentum]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| Community Care's Partnership Program (HMO D-SNP) | COMMUNITY CARE HEALTH PLAN, INC. | T1 | No | $0 | WI |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T1 | No | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T1 | No | $17.00 | AZ |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $34.50 | NY |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Flex (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Active (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Select Health Medicare Wellness (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Healthy Mississippi Premier Advantage (HMO-POS) | Healthy Mississippi, Inc. | T4 | No | $0 | MS |
| PHP (HMO C-SNP) | AIDS HEALTHCARE FOUNDATION | T4 | No | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS CHOICE | T4 | No | $0 | NY |
| FHCP Medicare Classic (HMO) | FLORIDA BLUE MEDICARE, INC. | T4 | No | $0 | FL |
| Leon MediExtra (HMO) | LEON HEALTH, INC. | T4 | No | $0 | FL |
| Leon MediDual (HMO D-SNP) | LEON HEALTH, INC. | T4 | No | $0 | FL |
| Leon MediMore (HMO) | LEON HEALTH, INC. | T4 | No | $0 | FL |
| Leon MediMax (HMO D-SNP) | LEON HEALTH, INC. | T4 | No | $0 | FL |
| FHCP Medicare Rx Plus (HMO-POS) | FLORIDA BLUE MEDICARE, INC. | T4 | No | $49.00 | FL |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS CHOICE | T4 | No | $51.60 | NY |
| Alignment Health the ONE + Walgreens (HMO) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | No | $0 | AZ |
| Alignment Health the ONE + Walgreens (HMO) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | No | $0 | AZ |
| Alignment Health Heart & Diabetes (HMO C-SNP) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | No | $0 | AZ |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | No | $0 | AZ |
| Alignment Health My Choice (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health Platinum + Instacart (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health Heart & Diabetes (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health AllCare Preferred (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health Platinum + Instacart (HMO-POS) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health My Choice (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health Harmony (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health Balance (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health the ONE (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health the ONE + Walgreens (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health CommUnity (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health smartSavings (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health My Choice Select (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
Frequently Asked Questions
Is olsalazine sodium 250 MG Oral Capsule [Dipentum] covered by Medicare Part D?
Yes, olsalazine sodium 250 MG Oral Capsule [Dipentum] is covered by 285 Medicare Part D plans (5.6% of all Part D formularies).
What tier is olsalazine sodium 250 MG Oral Capsule [Dipentum] on Medicare Part D plans?
olsalazine sodium 250 MG Oral Capsule [Dipentum] averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 6.
Does olsalazine sodium 250 MG Oral Capsule [Dipentum] require prior authorization?
0% of Part D formularies require prior authorization for olsalazine sodium 250 MG Oral Capsule [Dipentum]. Step therapy: 45.8%. Quantity limits: 0%.
How much does Medicare spend on olsalazine sodium 250 MG Oral Capsule [Dipentum]?
In 2023, total Medicare Part D spending on olsalazine sodium 250 MG Oral Capsule [Dipentum] was $2,854,712, covering 215 beneficiaries. The average spend per beneficiary was $13,277.73.
Read our methodology - how this data is sourced, computed, and verified.