Medicare Part D coverage · phenytoin · RxCUI 1313884
phenytoin 25 MG/ML Oral Suspension [Dilantin]
Per the CMS 2026 Part D formulary file, phenytoin 25 MG/ML Oral Suspension [Dilantin] is covered by 1,129 Medicare Part D plans (22.3% of enrollable products), averaging Tier 3.6, with prior authorization required on 4.2% of covering formularies.
- 22.3%
- Plan coverage
- 1,129
- Plans covering
- T3.6
- Avg tier
- 4.2%
- Prior auth required
What the CMS Formulary Data Shows for phenytoin 25 MG/ML Oral Suspension [Dilantin]
Per the CMS 2026 Part D formulary file, phenytoin 25 MG/ML Oral Suspension [Dilantin] (RxNorm concept RXCUI 1313884, generic name phenytoin) appears on 24 distinct formulary files spanning 1,129 Medicare Part D plan offerings - 22.3% 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 3.6.
Real-world access to phenytoin 25 MG/ML Oral Suspension [Dilantin] depends on utilization management as much as tier placement: 4.2% of covering formularies require prior authorization. 0% require step therapy. 8.3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 14,557 Part D beneficiaries filled phenytoin 25 MG/ML Oral Suspension [Dilantin] in 2023, with total plan-and-beneficiary spending of $4,008,684 and an average per-beneficiary annual cost of $275.38. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry phenytoin 25 MG/ML Oral Suspension [Dilantin] today.
Coverage Details
- Formularies covering
- 24
- Plans covering
- 1,129
- Coverage rate
- 22.3%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 4.2% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 8.3% of formularies
2023 Medicare Spending
- Beneficiaries
- 14,557
- Total spending
- $4,008,684
- Avg per beneficiary
- $275.38
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering phenytoin 25 MG/ML Oral Suspension [Dilantin]
100 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 |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | No | $0 | CA |
| CareOregon Advantage Plus (HMO D-SNP) | Health Plan OF Careoregon, Inc. | T1 | No | $0 | OR |
| Hamaspik Medicare Select (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $34.50 | NY |
| SCAN Connections (HMO D-SNP) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Connections at Home (HMO D-SNP) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Classic (HMO) | Scan Health Plan Nevada, Inc. | T3 | No | $0 | NV |
| SCAN Balance (HMO C-SNP) | Scan Health Plan Nevada, Inc. | T3 | No | $0 | NV |
| SCAN Strive (HMO C-SNP) | Scan Health Plan Nevada, Inc. | T3 | No | $0 | NV |
| SCAN MyChoice (HMO) | Scan Health Plan Nevada, Inc. | T3 | No | $0 | NV |
| SCAN Classic (HMO) | Scan Desert Health Plan, Inc. | T3 | No | $0 | AZ |
| SCAN Balance (HMO C-SNP) | Scan Desert Health Plan, Inc. | T3 | No | $0 | AZ |
| SCAN Embrace (HMO-POS I-SNP) | Scan Desert Health Plan, Inc. | T3 | No | $0 | AZ |
| SCAN Strive (HMO C-SNP) | Scan Desert Health Plan, Inc. | T3 | No | $0 | AZ |
| SCAN MyChoice (HMO) | Scan Desert Health Plan, Inc. | T3 | No | $0 | AZ |
| SCAN Classic WA (HMO) | Scan Health Plan (WA) | T3 | No | $0 | WA |
| SCAN MyChoice WA (HMO) | Scan Health Plan (WA) | T3 | No | $0 | WA |
| SCAN Classic (HMO) | Scan Health Plan (NM) | T3 | No | $0 | NM |
| SCAN Balance (HMO C-SNP) | Scan Health Plan (NM) | T3 | No | $0 | NM |
| SCAN Strive (HMO C-SNP) | Scan Health Plan (NM) | T3 | No | $0 | NM |
Show the next 30 plans
| SCAN MyChoice (HMO) | Scan Health Plan (NM) | T3 | No | $0 | NM |
| SCAN Classic (HMO) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Classic (HMO) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Classic (HMO) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Classic (HMO) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Classic (HMO) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Classic (HMO) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Classic (HMO) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Balance (HMO C-SNP) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Prime (HMO) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Classic (HMO) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Balance (HMO C-SNP) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Classic (HMO) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Balance (HMO C-SNP) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Alta (HMO) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Venture (HMO) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Venture (HMO) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Embrace (HMO I-SNP) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Embrace (HMO I-SNP) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Embrace (HMO-POS I-SNP) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Affirm partnered with Included LGBTQ+ Health (HMO) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Affirm partnered with Included LGBTQ+ Health (HMO) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Strive (HMO C-SNP) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Strive (HMO C-SNP) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Inspired by women for women (HMO) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Classic (HMO) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Balance (HMO C-SNP) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Balance (HMO C-SNP) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Balance (HMO C-SNP) | Scan Health Plan | T3 | No | $0 | CA |
| SCAN Balance (HMO C-SNP) | Scan Health Plan | T3 | No | $0 | CA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is phenytoin 25 MG/ML Oral Suspension [Dilantin] covered by Medicare Part D?
Yes, phenytoin 25 MG/ML Oral Suspension [Dilantin] is covered by 1,129 Medicare Part D plans (22.3% of all Part D formularies).
What tier is phenytoin 25 MG/ML Oral Suspension [Dilantin] on Medicare Part D plans?
phenytoin 25 MG/ML Oral Suspension [Dilantin] averages Tier 3.6 across Part D plans, ranging from Tier 1 to Tier 4.
Does phenytoin 25 MG/ML Oral Suspension [Dilantin] require prior authorization?
4.2% of Part D formularies require prior authorization for phenytoin 25 MG/ML Oral Suspension [Dilantin]. Step therapy: 0%. Quantity limits: 8.3%.
How much does Medicare spend on phenytoin 25 MG/ML Oral Suspension [Dilantin]?
In 2023, total Medicare Part D spending on phenytoin 25 MG/ML Oral Suspension [Dilantin] was $4,008,684, covering 14,557 beneficiaries. The average spend per beneficiary was $275.38.
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
Similar prior-authorization rate
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