pantoprazole 40 MG Oral Granules
pantoprazole
RxCUI: 763306
What the CMS Formulary Data Shows for pantoprazole 40 MG Oral Granules
Per the CMS 2026 Part D formulary file, pantoprazole 40 MG Oral Granules (RxNorm concept RXCUI 763306, generic name pantoprazole) appears on 10 distinct formulary files spanning 33 Medicare Part D plan offerings - 0.7% 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 1.8.
Real-world access to pantoprazole 40 MG Oral Granules depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 60% require step therapy. 80% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 6,191,845 Part D beneficiaries filled pantoprazole 40 MG Oral Granules in 2023, with total plan-and-beneficiary spending of $384,047,698 and an average per-beneficiary annual cost of $62.02. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry pantoprazole 40 MG Oral Granules today.
Coverage Details
- Formularies covering
- 10
- Plans covering
- 33
- Coverage rate
- 0.7%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 60% of formularies
- Quantity limits
- 80% of formularies
2023 Medicare Spending
- Beneficiaries
- 6,191,845
- Total spending
- $384,047,698
- Avg per beneficiary
- $62.02
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering pantoprazole 40 MG Oral Granules
33 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Abilis Health Community (HMO I-SNP) | SIGNATURE ADVANTAGE, LLC | T1 | No | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | ARKANSAS SUPERIOR SELECT, INC. | T1 | No | $0 | AR |
| Community Care's Partnership Program (HMO D-SNP) | COMMUNITY CARE HEALTH PLAN, INC. | T1 | No | $0 | WI |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | TEXAS INDEPENDENCE HEALTH PLAN, INC. | T1 | No | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | TEXAS INDEPENDENCE HEALTH PLAN, INC. | T1 | No | $4.80 | TX |
| Tribute Select (HMO-POS I-SNP) | ARKANSAS SUPERIOR SELECT, INC. | T1 | No | $8.90 | AR |
| Valor Health Plan (HMO I-SNP) | TSG GUARD, INC. | T1 | No | $31.40 | OH |
| WV Senior Advantage (HMO I-SNP) | WEST VIRGINIA SENIOR ADVANTAGE, INC. | T1 | No | $32.70 | WV |
| Abilis Health (HMO I-SNP) | SIGNATURE ADVANTAGE, LLC | T1 | No | $35.90 | KY, TN |
| CommuniCare Advantage ISNP (HMO I-SNP) | OH CHS SNP INC. | T1 | No | $38.40 | IN, MD, OH |
| Network Health Select (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T3 | No | $0 | WI |
| Network Health Go (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T3 | No | $0 | WI |
| Network Health Anywhere (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T3 | No | $0 | WI |
| Network Health Choice (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T3 | No | $0 | WI |
| Network Health Zero (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T3 | No | $0 | WI |
| Network Health Cares (PPO D-SNP) | NETWORK HEALTH INSURANCE CORPORATION | T3 | No | $21.10 | WI |
| Network Health PlusRx (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T3 | No | $38.60 | WI |
| Network Health PremierRx (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T3 | No | $92.80 | WI |
| Personal Choice 65 Achieve Rx (PPO) | QCC INSURANCE COMPANY | T4 | No | $0 | PA |
| Keystone 65 Focus Rx (HMO-POS) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | No | $0 | PA |
| Keystone 65 Focus Rx (HMO-POS) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | No | $0 | PA |
| Keystone 65 Basic Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | No | $0 | PA |
| AmeriHealth Medicare Core (PPO) | AMERIHEALTH INSURANCE COMPANY OF NEW JERSEY | T4 | No | $0 | NJ |
| AmeriHealth Medicare Ultimate (PPO) | AMERIHEALTH INSURANCE COMPANY OF NEW JERSEY | T4 | No | $0 | NJ |
| Keystone 65 Essential Rx (HMO-POS) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | No | $31.00 | PA |
| AmeriHealth Medicare Enhanced (PPO) | AMERIHEALTH INSURANCE COMPANY OF NEW JERSEY | T4 | No | $36.00 | NJ |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | No | $47.00 | PA |
| Keystone 65 Preferred Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | No | $59.70 | PA |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | No | $63.50 | PA |
| Keystone 65 Preferred Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | No | $79.70 | PA |
| Personal Choice 65 Plus Rx (PPO) | QCC INSURANCE COMPANY | T4 | No | $81.20 | PA |
| Personal Choice 65 Rx (PPO) | QCC INSURANCE COMPANY | T4 | No | $102.20 | PA |
| Personal Choice 65 Rx (PPO) | QCC INSURANCE COMPANY | T4 | No | $112.70 | PA |
Frequently Asked Questions
Is pantoprazole 40 MG Oral Granules covered by Medicare Part D?
Yes, pantoprazole 40 MG Oral Granules is covered by 33 Medicare Part D plans (0.7% of all Part D formularies).
What tier is pantoprazole 40 MG Oral Granules on Medicare Part D plans?
pantoprazole 40 MG Oral Granules averages Tier 1.8 across Part D plans, ranging from Tier 1 to Tier 4.
Does pantoprazole 40 MG Oral Granules require prior authorization?
0% of Part D formularies require prior authorization for pantoprazole 40 MG Oral Granules. Step therapy: 60%. Quantity limits: 80%.
How much does Medicare spend on pantoprazole 40 MG Oral Granules?
In 2023, total Medicare Part D spending on pantoprazole 40 MG Oral Granules was $384,047,698, covering 6,191,845 beneficiaries. The average spend per beneficiary was $62.02.
Read our methodology - how this data is sourced, computed, and verified.