Medicare Part D coverage · omeprazole · RxCUI 616539
omeprazole 20 MG / sodium bicarbonate 1100 MG Oral Capsule
Per the CMS 2026 Part D formulary file, omeprazole 20 MG / sodium bicarbonate 1100 MG Oral Capsule is covered by 54 Medicare Part D plans (1.1% of enrollable products), averaging Tier 3.6, with prior authorization required on 0% of covering formularies.
- 1.1%
- Plan coverage
- 54
- Plans covering
- T3.6
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for omeprazole 20 MG / sodium bicarbonate 1100 MG Oral Capsule
Per the CMS 2026 Part D formulary file, omeprazole 20 MG / sodium bicarbonate 1100 MG Oral Capsule (RxNorm concept RXCUI 616539, generic name omeprazole) appears on 14 distinct formulary files spanning 54 Medicare Part D plan offerings - 1.1% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 3.6.
Real-world access to omeprazole 20 MG / sodium bicarbonate 1100 MG Oral Capsule depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 71.4% require step therapy. 71.4% 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 / sodium bicarbonate 1100 MG 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 / sodium bicarbonate 1100 MG Oral Capsule today.
Coverage Details
- Formularies covering
- 14
- Plans covering
- 54
- Coverage rate
- 1.1%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 71.4% of formularies
- Quantity limits
- 71.4% of formularies
2023 Medicare Spending
- Beneficiaries
- 7,298,218
- Total spending
- $422,372,657
- Avg per beneficiary
- $57.87
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering omeprazole 20 MG / sodium bicarbonate 1100 MG Oral Capsule
54 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| 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 |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T4 | No | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T4 | No | $0 | NY |
| Prominence Plus (HMO) | Prominence Healthfirst | T4 | No | $0 | NV |
| Prominence Plus (HMO) | Prominence Healthfirst | T4 | No | $0 | NV |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst | T4 | No | $0 | NV |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst | T4 | No | $0 | NV |
| Prominence Giveback (HMO) | Prominence Healthfirst | T4 | No | $0 | NV |
| Prominence Plus (HMO) | Prominence Healthfirst OF Florida Inc | T4 | No | $0 | FL |
| Prominence Giveback (HMO) | Prominence Healthfirst OF Florida Inc | T4 | No | $0 | FL |
| Prominence Plus (HMO) | Prominence Healthfirst OF Texas | T4 | No | $0 | TX |
| Prominence Plus (HMO) | Prominence Healthfirst OF Texas | T4 | No | $0 | TX |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst OF Texas | T4 | No | $0 | TX |
| Prominence Extra Help (HMO) | Prominence Healthfirst OF Texas | T4 | No | $0 | TX |
| Prominence Beyond (HMO) | Prominence Healthfirst OF Texas | T4 | No | $0 | TX |
| Prominence Giveback (HMO) | Prominence Healthfirst OF Texas | T4 | No | $0 | TX |
| Prominence Giveback (HMO) | Prominence Healthfirst OF Texas | T4 | No | $0 | TX |
Show the next 30 plans
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst OF Texas | T4 | No | $0 | TX |
| Prominence Beyond (HMO-POS) | Prominence Healthfirst OF Texas | T4 | No | $0 | TX |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst OF Florida Inc | T4 | No | $0 | FL |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst | T4 | No | $0 | NV |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst OF Florida Inc | T4 | No | $0 | FL |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst OF Texas | T4 | No | $0 | TX |
| Prominence Diabetes and Heart Care Plus (HMO C-SNP) | Prominence Healthfirst OF Texas | T4 | No | $0 | TX |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst OF Texas | T4 | No | $0 | TX |
| Mass General Brigham Advantage (PPO) | Mass General Brigham Health Plan, Inc. | T4 | No | $0 | MA |
| Prominence Extra Help (HMO) | Prominence Healthfirst | T4 | No | $4.20 | NV |
| Prominence Extra Help (HMO) | Prominence Healthfirst OF Florida Inc | T4 | No | $4.80 | FL |
| Prominence Extra Help (HMO) | Prominence Healthfirst OF Texas | T4 | No | $4.80 | TX |
| Prominence Extra Help (HMO) | Prominence Healthfirst | T4 | No | $9.50 | NV |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS Choice | T4 | No | $51.60 | NY |
| Mass General Brigham Advantage Secure (HMO-POS) | Mass General Brigham Health Plan, Inc. | T4 | No | $62.00 | MA |
| Mass General Brigham Advantage Premier (PPO) | Mass General Brigham Health Plan, Inc. | T4 | No | $79.70 | MA |
| Mass General Brigham Advantage Signature (PPO) | Mass General Brigham Health Plan, Inc. | T4 | No | $147.20 | MA |
| SummaCare Medicare Topaz (HMO) | Summacare Inc. | T5 | No | $0 | OH |
| SummaCare Medicare Quartz (HMO) | Summacare Inc. | T5 | No | $0 | OH |
| Gold Heart & Diabetes (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T5 | No | $0 | FL |
| Gold Heart & Diabetes Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T5 | No | $0 | FL |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T5 | No | $0 | FL |
| Gold Health (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T5 | No | $0 | FL |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T5 | No | $0 | FL |
| Gold Heart & Diabetes (HMO-POS C-SNP) | Gold Kidney OF Arizona | T5 | No | $0 | AZ |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | Gold Kidney OF Arizona | T5 | No | $0 | AZ |
| Gold Heart & Diabetes (HMO-POS C-SNP) | Gold Kidney OF Arizona | T5 | No | $0 | AZ |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | Gold Kidney OF Arizona | T5 | No | $0 | AZ |
| VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) | Village Senior Services Corporation | T5 | No | $0 | NY |
| VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) | Village Senior Services Corporation | T5 | No | $0 | NY |
Showing top 50 of 54 plans.
Frequently Asked Questions
Is omeprazole 20 MG / sodium bicarbonate 1100 MG Oral Capsule covered by Medicare Part D?
Yes, omeprazole 20 MG / sodium bicarbonate 1100 MG Oral Capsule is covered by 54 Medicare Part D plans (1.1% of all Part D formularies).
What tier is omeprazole 20 MG / sodium bicarbonate 1100 MG Oral Capsule on Medicare Part D plans?
omeprazole 20 MG / sodium bicarbonate 1100 MG Oral Capsule averages Tier 3.6 across Part D plans, ranging from Tier 1 to Tier 5.
Does omeprazole 20 MG / sodium bicarbonate 1100 MG Oral Capsule require prior authorization?
0% of Part D formularies require prior authorization for omeprazole 20 MG / sodium bicarbonate 1100 MG Oral Capsule. Step therapy: 71.4%. Quantity limits: 71.4%.
How much does Medicare spend on omeprazole 20 MG / sodium bicarbonate 1100 MG Oral Capsule?
In 2023, total Medicare Part D spending on omeprazole 20 MG / sodium bicarbonate 1100 MG 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
- eslicarbazepine acetate 200 MG Oral Tablet T3.6
- 12 HR hydrocodone bitartrate 10 MG Extended Release Oral Capsule T3.6
- cyclosporine 100 MG Oral Capsule [Sandimmune] T3.6
- 24 HR bupropion hydrobromide 174 MG Extended Release Oral Tablet [Aplenzin] T3.6
- ciprofloxacin 2 MG/ML / hydrocortisone 10 MG/ML Otic Suspension [Cipro HC] T3.6
- alanine 8.8 MG/ML / arginine 4.89 MG/ML / calcium chloride 0.004 MEQ/ML / dibasic potassium phosphate 2.61 MG/ML / glucose 100 MG/ML / glycine 4.38 MG/ML / histidine 2.04 MG/ML / isoleucine 2.55 MG/ML / leucine 3.11 MG/ML / lysine 2.47 MG/ML / magnesium chloride 0.01 MEQ/ML / methionine 1.7 MG/ML / phenylalanine 2.38 MG/ML / proline 2.89 MG/ML / serine 2.13 MG/ML / sodium acetate trihydrate 2.97 MG/ML / sodium chloride 0.013 MEQ/ML / threonine 1.79 MG/ML / tryptophan 0.77 MG/ML / tyrosine 0.17 MG/ML / valine 2.47 MG/ML Injectable Solution [Clinimix E 4.25/10] T3.6