Medicare Part D coverage · omeprazole · RxCUI 198051
omeprazole 20 MG Delayed Release Oral Capsule
Per the CMS 2026 Part D formulary file, omeprazole 20 MG Delayed Release Oral Capsule is covered by 5,052 Medicare Part D plans (100% of enrollable products), averaging Tier 1.2, with prior authorization required on 0% of covering formularies.
- 100%
- Plan coverage
- 5,052
- Plans covering
- T1.2
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for omeprazole 20 MG Delayed Release Oral Capsule
Per the CMS 2026 Part D formulary file, omeprazole 20 MG Delayed Release Oral Capsule (RxNorm concept RXCUI 198051, generic name omeprazole) 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 6, with a cross-plan average of Tier 1.2.
Real-world access to omeprazole 20 MG Delayed Release Oral Capsule depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 42.7% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 7,298,218 Part D beneficiaries filled omeprazole 20 MG Delayed Release Oral Capsule in 2023, with total plan-and-beneficiary spending of $422,372,657 and an average per-beneficiary annual cost of $57.87. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry omeprazole 20 MG Delayed Release Oral Capsule today.
Coverage Details
- Formularies covering
- 328
- Plans covering
- 5,052
- Coverage rate
- 100%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 1, Preferred Generic
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 42.7% of formularies
2023 Medicare Spending
- Beneficiaries
- 7,298,218
- Total spending
- $422,372,657
- Avg per beneficiary
- $57.87
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering omeprazole 20 MG Delayed Release Oral Capsule
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T1 | No | No | $0 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T1 | No | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering omeprazole 20 MG Delayed Release Oral Capsule
98 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| UHC Dual Complete IA-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T1 | No | $0 | IA |
| UHC Dual Complete MO-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T1 | No | $0 | MO |
| UHC Dual Complete NE-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T1 | No | $0 | NE |
| UHC Dual Complete KS-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T1 | No | $0 | KS |
| UHC Dual Complete MO-S3 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T1 | No | $0 | MO |
| UHC Dual Complete KS-Q1 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T1 | No | $0 | KS |
| UHC Dual Complete TN-S001 (HMO-POS D-SNP) | Unitedhealthcare Plan OF THE River Valley, Inc. | T1 | No | $0 | TN |
| UHC Dual Complete TN-Y001 (HMO-POS D-SNP) | Unitedhealthcare Plan OF THE River Valley, Inc. | T1 | No | $0 | TN |
| UHC Dual Complete TN-Y2 (HMO-POS D-SNP) | Unitedhealthcare Plan OF THE River Valley, Inc. | T1 | No | $0 | TN |
| AARP Medicare Advantage from UHC MI-0001 (PPO) | Unitedhealthcare Insurance Company | T1 | No | $0 | MI |
| UHC Dual Complete NM-Y1 (PPO D-SNP) | Unitedhealthcare Insurance Company | T1 | No | $0 | NM |
| UHC Dual Complete NM-S1 (PPO D-SNP) | Unitedhealthcare Insurance Company | T1 | No | $0 | NM |
| UHC Dual Complete NM-V1 (PPO D-SNP) | Unitedhealthcare Insurance Company | T1 | No | $0 | NM |
| UHC Dual Complete AZ-S001 (HMO-POS D-SNP) | Arizona Physicians IPA, Inc. | T1 | No | $0 | AZ |
| UHC Dual Complete AZ-Y001 (HMO-POS D-SNP) | Arizona Physicians IPA, Inc. | T1 | No | $0 | AZ |
| UHC Dual Complete VA-Y4 (PPO D-SNP) | Care Improvement Plus South Central Insurance Co. | T1 | No | $0 | VA |
| AARP Medicare Advantage from UHC AL-0001 (HMO-POS) | Unitedhealthcare OF THE Midlands, Inc. | T1 | No | $0 | AL |
| AARP Medicare Advantage from UHC CA-0002 (HMO-POS) | UHC OF California | T1 | No | $0 | CA |
| UHC Sharp Medicare Advantage CA-001P (HMO-POS) | UHC OF California | T1 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-003P (HMO-POS) | UHC OF California | T1 | No | $0 | CA |
Show the next 30 plans
Showing top 50 of 98 plans.
Frequently Asked Questions
Is omeprazole 20 MG Delayed Release Oral Capsule covered by Medicare Part D?
Yes, omeprazole 20 MG Delayed Release Oral Capsule is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).
What tier is omeprazole 20 MG Delayed Release Oral Capsule on Medicare Part D plans?
omeprazole 20 MG Delayed Release Oral Capsule averages Tier 1.2 across Part D plans, ranging from Tier 1 to Tier 6.
Does omeprazole 20 MG Delayed Release Oral Capsule require prior authorization?
0% of Part D formularies require prior authorization for omeprazole 20 MG Delayed Release Oral Capsule. Step therapy: 0%. Quantity limits: 42.7%.
How much does Medicare spend on omeprazole 20 MG Delayed Release Oral Capsule?
In 2023, total Medicare Part D spending on omeprazole 20 MG Delayed Release Oral Capsule was $422,372,657, covering 7,298,218 beneficiaries. The average spend per beneficiary was $57.87.
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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