pantoprazole 20 MG Delayed Release Oral Tablet [Protonix]
pantoprazole
RxCUI: 352125
What the CMS Formulary Data Shows for pantoprazole 20 MG Delayed Release Oral Tablet [Protonix]
Per the CMS 2026 Part D formulary file, pantoprazole 20 MG Delayed Release Oral Tablet [Protonix] (RxNorm concept RXCUI 352125, generic name pantoprazole) appears on 1 distinct formulary file spanning 2 Medicare Part D plan offerings - 0% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 1, with a cross-plan average of Tier 1.
Real-world access to pantoprazole 20 MG Delayed Release Oral Tablet [Protonix] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 100% require step therapy. 100% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 6,191,845 Part D beneficiaries filled pantoprazole 20 MG Delayed Release Oral Tablet [Protonix] 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 20 MG Delayed Release Oral Tablet [Protonix] today.
Coverage Details
- Formularies covering
- 1
- Plans covering
- 2
- Coverage rate
- 0%
- Tier range
- Tier 1, Preferred Generic
- Average tier
- Tier 1, Preferred Generic
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 100% of formularies
- Quantity limits
- 100% 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 20 MG Delayed Release Oral Tablet [Protonix]
2 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $34.50 | NY |
Frequently Asked Questions
Is pantoprazole 20 MG Delayed Release Oral Tablet [Protonix] covered by Medicare Part D?
Yes, pantoprazole 20 MG Delayed Release Oral Tablet [Protonix] is covered by 2 Medicare Part D plans (0% of all Part D formularies).
What tier is pantoprazole 20 MG Delayed Release Oral Tablet [Protonix] on Medicare Part D plans?
pantoprazole 20 MG Delayed Release Oral Tablet [Protonix] averages Tier 1 across Part D plans, ranging from Tier 1 to Tier 1.
Does pantoprazole 20 MG Delayed Release Oral Tablet [Protonix] require prior authorization?
0% of Part D formularies require prior authorization for pantoprazole 20 MG Delayed Release Oral Tablet [Protonix]. Step therapy: 100%. Quantity limits: 100%.
How much does Medicare spend on pantoprazole 20 MG Delayed Release Oral Tablet [Protonix]?
In 2023, total Medicare Part D spending on pantoprazole 20 MG Delayed Release Oral Tablet [Protonix] 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.