Medicare Part D coverage · omeprazole · RxCUI 616541
omeprazole 40 MG / sodium bicarbonate 1100 MG Oral Capsule
Per the CMS 2026 Part D formulary file, omeprazole 40 MG / sodium bicarbonate 1100 MG Oral Capsule is covered by 54 Medicare Part D plans (1.1% of enrollable products), averaging Tier 2.8, with prior authorization required on 0% of covering formularies.
- 1.1%
- Plan coverage
- 54
- Plans covering
- T2.8
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for omeprazole 40 MG / sodium bicarbonate 1100 MG Oral Capsule
Per the CMS 2026 Part D formulary file, omeprazole 40 MG / sodium bicarbonate 1100 MG Oral Capsule (RxNorm concept RXCUI 616541, 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 4, with a cross-plan average of Tier 2.8.
Real-world access to omeprazole 40 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 40 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 40 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 4
- Average tier
- Tier 3, Preferred Brand
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 40 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 |
|---|---|---|---|---|---|
| PHP (HMO C-snp) | Aids Healthcare Foundation | T1 | No | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T1 | No | $0 | NY |
| 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 |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS Choice | T1 | No | $51.60 | NY |
| Gold Heart & Diabetes (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T2 | No | $0 | FL |
| Gold Heart & Diabetes Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T2 | No | $0 | FL |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T2 | No | $0 | FL |
| Gold Health (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T2 | No | $0 | FL |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T2 | No | $0 | FL |
| Gold Heart & Diabetes (HMO-POS C-SNP) | Gold Kidney OF Arizona | T2 | No | $0 | AZ |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | Gold Kidney OF Arizona | T2 | No | $0 | AZ |
| Gold Heart & Diabetes (HMO-POS C-SNP) | Gold Kidney OF Arizona | T2 | No | $0 | AZ |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | Gold Kidney OF Arizona | T2 | No | $0 | AZ |
| SummaCare Medicare Topaz (HMO) | Summacare Inc. | T4 | No | $0 | OH |
| SummaCare Medicare Quartz (HMO) | Summacare Inc. | T4 | No | $0 | OH |
| VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) | Village Senior Services Corporation | T4 | No | $0 | NY |
| VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) | Village Senior Services Corporation | T4 | No | $0 | NY |
Show the next 30 plans
| 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 |
| SummaCare Medicare Garnet (HMO) | Summacare Inc. | T4 | No | $35.00 | OH |
| SummaCare Medicare Ruby (HMO) | Summacare Inc. | T4 | No | $50.00 | OH |
| Mass General Brigham Advantage Secure (HMO-POS) | Mass General Brigham Health Plan, Inc. | T4 | No | $62.00 | MA |
Showing top 50 of 54 plans.
Frequently Asked Questions
Is omeprazole 40 MG / sodium bicarbonate 1100 MG Oral Capsule covered by Medicare Part D?
Yes, omeprazole 40 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 40 MG / sodium bicarbonate 1100 MG Oral Capsule on Medicare Part D plans?
omeprazole 40 MG / sodium bicarbonate 1100 MG Oral Capsule averages Tier 2.8 across Part D plans, ranging from Tier 1 to Tier 4.
Does omeprazole 40 MG / sodium bicarbonate 1100 MG Oral Capsule require prior authorization?
0% of Part D formularies require prior authorization for omeprazole 40 MG / sodium bicarbonate 1100 MG Oral Capsule. Step therapy: 71.4%. Quantity limits: 71.4%.
How much does Medicare spend on omeprazole 40 MG / sodium bicarbonate 1100 MG Oral Capsule?
In 2023, total Medicare Part D spending on omeprazole 40 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
- {11 (varenicline 0.5 MG Oral Tablet) / 42 (varenicline 1 MG Oral Tablet) } Pack T2.8
- ceftriaxone 100 MG/ML Injectable Solution T2.8
- {56 (varenicline 1 MG Oral Tablet) } Pack T2.8
- levocarnitine 100 MG/ML Oral Solution T2.8
- 1000 ML glucose 50 MG/ML / potassium chloride 0.03 MEQ/ML / sodium chloride 4.5 MG/ML Injection T2.8
- bromfenac 0.75 MG/ML Ophthalmic Solution T2.8
Similar prior-authorization rate
- metronidazole 10 MG/ML Topical Cream [Noritate] 0% PA
- 24 HR minocycline 40 MG Extended Release Oral Capsule [Emrosi] 0% PA
- buspirone hydrochloride 10 MG Oral Capsule [Bucapsol] 0% PA
- diflunisal 375 MG Oral Tablet [Dolobid] 0% PA
- hydrocortisone 1 MG/ML Oral Solution [Khindivi] 0% PA
- indomethacin 50 MG Rectal Suppository [Indocin] 0% PA