phenytoin sodium 100 MG Extended Release Oral Capsule [Dilantin]

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phenytoin sodium

RxCUI: 855673

Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.
45.4%
Plan Coverage
2,299
Plans Covering
T3.4
Avg Tier
8%
Prior Auth Required

What the CMS Formulary Data Shows for phenytoin sodium 100 MG Extended Release Oral Capsule [Dilantin]

Per the CMS 2026 Part D formulary file, phenytoin sodium 100 MG Extended Release Oral Capsule [Dilantin] (RxNorm concept RXCUI 855673, generic name phenytoin sodium) appears on 50 distinct formulary files spanning 2,299 Medicare Part D plan offerings - 45.4% 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 3.4.

Real-world access to phenytoin sodium 100 MG Extended Release Oral Capsule [Dilantin] depends on utilization management as much as tier placement: 8% of covering formularies require prior authorization. 0% require step therapy. 4% apply quantity limits.

Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 11 Part D beneficiaries filled phenytoin sodium 100 MG Extended Release Oral Capsule [Dilantin] in 2023, with total plan-and-beneficiary spending of $3,559 and an average per-beneficiary annual cost of $323.56. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry phenytoin sodium 100 MG Extended Release Oral Capsule [Dilantin] today.

Coverage Details

Formularies covering
50
Plans covering
2,299
Coverage rate
45.4%
Tier range
Tier 1 – Tier 4
Average tier
Tier 3, Preferred Brand

Restrictions

Prior authorization required
8% of formularies
Step therapy required
0% of formularies
Quantity limits
4% of formularies

2023 Medicare Spending

Beneficiaries
11
Total spending
$3,559
Avg per beneficiary
$323.56

Tier Distribution Across Plans

8 plans
Tier 1, Preferred Generic
92 plans
Tier 2, Generic

Medicare Advantage Plans (MA-PD) Covering phenytoin sodium 100 MG Extended Release Oral Capsule [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
Mass General Brigham SCO (HMO D-SNP) MASS GENERAL BRIGHAM HEALTH PLAN, INC T1 No $0 MA
Mass General Brigham One Care (HMO D-SNP) MASS GENERAL BRIGHAM HEALTH PLAN, INC T1 No $0 MA
CareOregon Advantage Plus (HMO D-SNP) HEALTH PLAN OF CAREOREGON, INC. T1 No $0 OR
VIVA Medicare Extra Value (HMO D-SNP) VIVA HEALTH, INC. T1 No $27.70 AL
VIVA Medicare Extra Care (HMO D-SNP) VIVA HEALTH, INC. T1 No $27.70 AL
Hamaspik Medicare Select (HMO D-SNP) HAMASPIK, INC. T1 No $34.50 NY
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Solano (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Inland Empire (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Ventura (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Kern (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Kern (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage San Diego (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Stanis (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Fresno (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Santa Cruz (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Alameda (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic SF (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Solano (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Advantage Inland Empire Value (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage San Diego Value (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Ventura Value (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Core DM (HMO) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Dual Essential (HMO D-SNP) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Silver DM (HMO-POS) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Core South (HMO) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Core North (HMO) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Bronze DM (HMO-POS) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Dual Complete (HMO D-SNP) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Senior Advantage Basic 1 (HMO) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Senior Advantage Basic 2 (HMO) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Dual Complete (HMO D-SNP) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Senior Advantage Basic (HMO) KAISER FOUNDATION HP, INC. T2 No $0 HI
Kaiser Permanente Medicare Advantage Value 1 VA (HMO-POS) KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES T2 No $0 VA

Frequently Asked Questions

Is phenytoin sodium 100 MG Extended Release Oral Capsule [Dilantin] covered by Medicare Part D?

Yes, phenytoin sodium 100 MG Extended Release Oral Capsule [Dilantin] is covered by 2,299 Medicare Part D plans (45.4% of all Part D formularies).

What tier is phenytoin sodium 100 MG Extended Release Oral Capsule [Dilantin] on Medicare Part D plans?

phenytoin sodium 100 MG Extended Release Oral Capsule [Dilantin] averages Tier 3.4 across Part D plans, ranging from Tier 1 to Tier 4.

Does phenytoin sodium 100 MG Extended Release Oral Capsule [Dilantin] require prior authorization?

8% of Part D formularies require prior authorization for phenytoin sodium 100 MG Extended Release Oral Capsule [Dilantin]. Step therapy: 0%. Quantity limits: 4%.

How much does Medicare spend on phenytoin sodium 100 MG Extended Release Oral Capsule [Dilantin]?

In 2023, total Medicare Part D spending on phenytoin sodium 100 MG Extended Release Oral Capsule [Dilantin] was $3,559, covering 11 beneficiaries. The average spend per beneficiary was $323.56.

Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare Editorial