omeprazole 20 MG / sodium bicarbonate 1100 MG Oral Capsule
omeprazole
RxCUI: 616539
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 $422,372,715 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
- $422,372,715
- 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 |
| 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 |
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 $422,372,715, covering 7,298,218 beneficiaries. The average spend per beneficiary was $57.87.
Read our methodology - how this data is sourced, computed, and verified.