Medicare Part D coverage · opicapone · RxCUI 2362178
opicapone 25 MG Oral Capsule [Ongentys]
Per the CMS 2026 Part D formulary file, opicapone 25 MG Oral Capsule [Ongentys] is covered by 309 Medicare Part D plans (6.1% of enrollable products), averaging Tier 3.3, with prior authorization required on 25.8% of covering formularies.
- 6.1%
- Plan coverage
- 309
- Plans covering
- T3.3
- Avg tier
- 25.8%
- Prior auth required
What the CMS Formulary Data Shows for opicapone 25 MG Oral Capsule [Ongentys]
Per the CMS 2026 Part D formulary file, opicapone 25 MG Oral Capsule [Ongentys] (RxNorm concept RXCUI 2362178, generic name opicapone) appears on 31 distinct formulary files spanning 309 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 25 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 25 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 25 MG Oral Capsule [Ongentys] today.
Coverage Details
- Formularies covering
- 31
- Plans covering
- 309
- 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 25 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 25 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 |
Show the next 30 plans
| 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) | Healthspring Healthcare OF Colorado, Inc. | T3 | No | $0 | NM |
| HealthSpring Preferred (HMO) | Healthspring Healthcare OF Colorado, Inc. | T3 | No | $0 | OH |
| HealthSpring Preferred (HMO) | Healthspring Healthcare OF Colorado, Inc. | T3 | No | $0 | KY, OH |
| HealthSpring Preferred Savings (HMO) | Healthspring Healthcare OF Colorado, Inc. | T3 | No | $0 | OH |
| HealthSpring Preferred Savings (HMO) | Healthspring Healthcare OF Colorado, Inc. | T3 | No | $0 | KY, OH |
| HealthSpring Preferred (HMO) | Healthspring 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 |
Showing top 50 of 91 plans.
Frequently Asked Questions
Is opicapone 25 MG Oral Capsule [Ongentys] covered by Medicare Part D?
Yes, opicapone 25 MG Oral Capsule [Ongentys] is covered by 309 Medicare Part D plans (6.1% of all Part D formularies).
What tier is opicapone 25 MG Oral Capsule [Ongentys] on Medicare Part D plans?
opicapone 25 MG Oral Capsule [Ongentys] averages Tier 3.3 across Part D plans, ranging from Tier 1 to Tier 4.
Does opicapone 25 MG Oral Capsule [Ongentys] require prior authorization?
25.8% of Part D formularies require prior authorization for opicapone 25 MG Oral Capsule [Ongentys]. Step therapy: 38.7%. Quantity limits: 35.5%.
How much does Medicare spend on opicapone 25 MG Oral Capsule [Ongentys]?
In 2023, total Medicare Part D spending on opicapone 25 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.
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
- 24 HR donepezil hydrochloride 10 MG / memantine hydrochloride 7 MG Extended Release Oral Capsule [Namzaric] T3.3
- 72 HR fentanyl 0.0875 MG/HR Transdermal System T3.3
- 24 HR nisoldipine 17 MG Extended Release Oral Tablet T3.3
- Preservative-Free timolol 2.5 MG/ML Ophthalmic Solution T3.3
- tretinoin 0.5 MG/ML Topical Lotion [Altreno] T3.3
- buprenorphine 2 MG / naloxone 0.5 MG Sublingual Film [Suboxone] T3.3
Similar prior-authorization rate
- acyclovir 0.05 MG/MG Topical Ointment 25.8% PA
- amitriptyline hydrochloride 12.5 MG / chlordiazepoxide 5 MG Oral Tablet 25.9% PA
- {2 (0.1 ML) (diazepam 100 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 20 MG Dose Kit] 25.9% PA
- {1 (0.1 ML) (diazepam 100 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 10 MG Dose Kit] 25.9% PA
- {2 (0.1 ML) (diazepam 75 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 15 MG Dose Kit] 25.9% PA
- amoxapine 150 MG Oral Tablet 25.6% PA