opicapone 50 MG Oral Capsule [Ongentys]
opicapone
RxCUI: 2362182
What the CMS Formulary Data Shows for opicapone 50 MG Oral Capsule [Ongentys]
Per the CMS 2026 Part D formulary file, opicapone 50 MG Oral Capsule [Ongentys] (RxNorm concept RXCUI 2362182, generic name opicapone) appears on 31 distinct formulary files spanning 310 Medicare Part D plan offerings - 6.1% 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 3.3.
Real-world access to opicapone 50 MG Oral Capsule [Ongentys] depends on utilization management as much as tier placement: 25.8% of covering formularies require prior authorization. 38.7% require step therapy. 35.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 3,270 Part D beneficiaries filled opicapone 50 MG Oral Capsule [Ongentys] in 2023, with total plan-and-beneficiary spending of $15,941,380 and an average per-beneficiary annual cost of $4,875.04. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry opicapone 50 MG Oral Capsule [Ongentys] today.
Coverage Details
- Formularies covering
- 31
- Plans covering
- 310
- Coverage rate
- 6.1%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 25.8% of formularies
- Step therapy required
- 38.7% of formularies
- Quantity limits
- 35.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 3,270
- Total spending
- $15,941,380
- Avg per beneficiary
- $4,875.04
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering opicapone 50 MG Oral Capsule [Ongentys]
9 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T3 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T3 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T3 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T3 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T3 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T3 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T3 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T3 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T3 | No | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering opicapone 50 MG Oral Capsule [Ongentys]
91 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| SeniorCare Complete (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | ALAMEDA ALLIANCE FOR HEALTH | T1 | No | $0 | CA |
| 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 | Yes | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T1 | Yes | $17.00 | AZ |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | No | $0 | CA |
| HealthSpring Preferred (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T3 | No | $0 | AZ |
| HealthSpring Alliance (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T3 | No | $0 | AZ |
| HealthSpring Preferred Savings (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T3 | No | $0 | AZ |
| HealthSpring Preferred Full Savings (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T3 | No | $0 | AZ |
| HealthSpring Preferred GA (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | GA |
| HealthSpring Preferred Savings (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | GA |
| HealthSpring Preferred Savings (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | GA |
| HealthSpring Preferred Savings (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | GA |
| HealthSpring Preferred Savings (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | MO |
| HealthSpring Preferred Savings (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | MO |
| HealthSpring Premier (HMO-POS) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | UT |
| HealthSpring Preferred (HMO) | CIGNA HEALTHCARE OF COLORADO, INC. | T3 | No | $0 | NM |
| HealthSpring Preferred (HMO) | CIGNA HEALTHCARE OF COLORADO, INC. | T3 | No | $0 | OH |
| HealthSpring Preferred (HMO) | CIGNA HEALTHCARE OF COLORADO, INC. | T3 | No | $0 | KY, OH |
| HealthSpring Preferred Savings (HMO) | CIGNA HEALTHCARE OF COLORADO, INC. | T3 | No | $0 | OH |
| HealthSpring Preferred Savings (HMO) | CIGNA HEALTHCARE OF COLORADO, INC. | T3 | No | $0 | KY, OH |
| HealthSpring Preferred (HMO) | CIGNA HEALTHCARE OF COLORADO, INC. | T3 | No | $0 | CO |
| HealthSpring Preferred (HMO) | BRAVO HEALTH MID-ATLANTIC, INC. | T3 | No | $0 | DC, DE |
| HealthSpring Preferred PA (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T3 | No | $0 | PA |
| HealthSpring Preferred (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T3 | No | $0 | PA |
| HealthSpring Preferred (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T3 | No | $0 | PA |
| HealthSpring Preferred (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T3 | No | $0 | PA |
| HealthSpring Preferred (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T3 | No | $0 | PA |
| HealthSpring Preferred (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T3 | No | $0 | PA |
| HealthSpring Preferred Savings (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T3 | No | $0 | PA |
| HealthSpring Preferred (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T3 | No | $0 | NJ |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | MS |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | WA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | OR, WA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | TX |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | TN |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | AR |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | MS, TN |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | AR |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T3 | No | $0 | AR |
Frequently Asked Questions
Is opicapone 50 MG Oral Capsule [Ongentys] covered by Medicare Part D?
Yes, opicapone 50 MG Oral Capsule [Ongentys] is covered by 310 Medicare Part D plans (6.1% of all Part D formularies).
What tier is opicapone 50 MG Oral Capsule [Ongentys] on Medicare Part D plans?
opicapone 50 MG Oral Capsule [Ongentys] averages Tier 3.3 across Part D plans, ranging from Tier 1 to Tier 4.
Does opicapone 50 MG Oral Capsule [Ongentys] require prior authorization?
25.8% of Part D formularies require prior authorization for opicapone 50 MG Oral Capsule [Ongentys]. Step therapy: 38.7%. Quantity limits: 35.5%.
How much does Medicare spend on opicapone 50 MG Oral Capsule [Ongentys]?
In 2023, total Medicare Part D spending on opicapone 50 MG Oral Capsule [Ongentys] was $15,941,380, covering 3,270 beneficiaries. The average spend per beneficiary was $4,875.04.
Read our methodology - how this data is sourced, computed, and verified.