Medicare Part D coverage · prasugrel · RxCUI 855818
prasugrel 5 MG Oral Tablet
Per the CMS 2026 Part D formulary file, prasugrel 5 MG Oral Tablet is covered by 4,973 Medicare Part D plans (98.4% of enrollable products), averaging Tier 2.3, with prior authorization required on 0% of covering formularies.
- 98.4%
- Plan coverage
- 4,973
- Plans covering
- T2.3
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for prasugrel 5 MG Oral Tablet
Per the CMS 2026 Part D formulary file, prasugrel 5 MG Oral Tablet (RxNorm concept RXCUI 855818, generic name prasugrel) appears on 322 distinct formulary files spanning 4,973 Medicare Part D plan offerings - 98.4% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.3.
Real-world access to prasugrel 5 MG Oral Tablet depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 37.3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 85,432 Part D beneficiaries filled prasugrel 5 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $30,426,210 and an average per-beneficiary annual cost of $356.15. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry prasugrel 5 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 322
- Plans covering
- 4,973
- Coverage rate
- 98.4%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 37.3% of formularies
2023 Medicare Spending
- Beneficiaries
- 85,432
- Total spending
- $30,426,210
- Avg per beneficiary
- $356.15
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering prasugrel 5 MG Oral Tablet
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| UHC Complete Care WI-1 (PPO C-SNP) | Unitedhealthcare Insurance Company | T1 | No | $0 | WI |
| UHC Complete Care AL-5 (HMO-POS C-SNP) | Unitedhealthcare OF THE Midlands, Inc. | T1 | No | $0 | AL |
| UHC Complete Care CA-15P (HMO-POS C-SNP) | UHC OF California | T1 | No | $0 | CA |
| UHC Complete Care CA-18P (HMO-POS C-SNP) | UHC OF California | T1 | No | $0 | CA |
| UHC Complete Care CA-19P (HMO-POS C-SNP) | UHC OF California | T1 | No | $0 | CA |
| UHC Complete Care CA-20P (HMO-POS C-SNP) | UHC OF California | T1 | No | $0 | CA |
| UHC Complete Care CA-27P (HMO-POS C-SNP) | UHC OF California | T1 | No | $0 | CA |
| UHC Complete Care NV-4 (HMO-POS C-SNP) | UnitedHealthcare Benefits of Texas, Inc. | T1 | No | $0 | NV |
| UHC Complete Care AZ-1P (HMO-POS C-SNP) | UnitedHealthcare Benefits of Texas, Inc. | T1 | No | $0 | AZ |
| UHC Complete Care AZ-3P (HMO-POS C-SNP) | UnitedHealthcare Benefits of Texas, Inc. | T1 | No | $0 | AZ |
| UHC Complete Care CO-1P (HMO-POS C-SNP) | UnitedHealthcare Benefits of Texas, Inc. | T1 | No | $0 | CO |
| UHC Complete Care CO-2P (HMO-POS C-SNP) | UnitedHealthcare Benefits of Texas, Inc. | T1 | No | $0 | CO |
| UHC Complete Care TX-24 (HMO-POS C-SNP) | UnitedHealthcare Benefits of Texas, Inc. | T1 | No | $0 | TX |
| UHC Complete Care TX-3P (HMO-POS C-SNP) | UnitedHealthcare Benefits of Texas, Inc. | T1 | No | $0 | TX |
| UHC Complete Care CO-19 (HMO-POS C-SNP) | UnitedHealthcare Benefits of Texas, Inc. | T1 | No | $0 | CO |
| UHC Complete Care Support NV-11 (HMO-POS C-SNP) | UnitedHealthcare Benefits of Texas, Inc. | T1 | No | $0 | NV |
| UHC Preferred Complete Care FL-0003 (HMO C-SNP) | Preferred Care Partners, Inc. | T1 | No | $0 | FL |
| UHC Complete Care FL-14 (HMO-POS C-SNP) | Preferred Care Partners, Inc. | T1 | No | $0 | FL |
| UHC Complete Care AR-5 (PPO C-SNP) | Care Improvement Plus South Central Insurance Co. | T1 | No | $0 | AR |
| UHC Complete Care GA-3 (PPO C-SNP) | Care Improvement Plus South Central Insurance Co. | T1 | No | $0 | GA |
Show the next 30 plans
| UHC Complete Care AR-6 (PPO C-SNP) | Care Improvement Plus South Central Insurance Co. | T1 | No | $0 | AR |
| Peoples Health Complete Care LA-5 (HMO-POS C-SNP) | Peoples Health, Inc. | T1 | No | $0 | LA |
| Peoples Health Complete Care LA-6 (HMO-POS C-SNP) | Peoples Health, Inc. | T1 | No | $0 | LA |
| Peoples Health Complete Care LA-7 (HMO-POS C-SNP) | Peoples Health, Inc. | T1 | No | $0 | LA |
| UHC Complete Care Support NM-1A (PPO C-SNP) | Sierra Health AND Life Insurance Company, Inc. | T1 | No | $0 | NM |
| UHC Complete Care Support EP-1A (PPO C-SNP) | Sierra Health AND Life Insurance Company, Inc. | T1 | No | $0 | NM |
| UHC Complete Care Support NM-2A (PPO C-SNP) | Sierra Health AND Life Insurance Company, Inc. | T1 | No | $0 | NM |
| UHC Complete Care MO-1 (PPO C-SNP) | Sierra Health AND Life Insurance Company, Inc. | T1 | No | $0 | MO |
| UHC Complete Care SC-1 (PPO C-SNP) | Sierra Health AND Life Insurance Company, Inc. | T1 | No | $0 | SC |
| UHC Complete Care NM-11 (PPO C-SNP) | Sierra Health AND Life Insurance Company, Inc. | T1 | No | $0 | NM |
| UHC Complete Care MN-7 (PPO C-SNP) | Sierra Health AND Life Insurance Company, Inc. | T1 | No | $0 | MN |
| UHC Complete Care IN-21 (HMO-POS C-SNP) | Unitedhealthcare OF THE Midlands, Inc. | T1 | No | $0 | IN |
| UHC Complete Care KS-4 (HMO-POS C-SNP) | Unitedhealthcare OF THE Midlands, Inc. | T1 | No | $0 | KS |
| UHC Complete Care NY-30 (HMO-POS C-SNP) | Unitedhealthcare OF NEW York, Inc. | T1 | No | $0 | NY |
| UHC Complete Care NY-31 (HMO-POS C-SNP) | Unitedhealthcare OF NEW York, Inc. | T1 | No | $0 | NY |
| UHC Complete Care NY-33 (HMO-POS C-SNP) | Unitedhealthcare OF NEW York, Inc. | T1 | No | $0 | NY |
| UHC Complete Care OR-5 (HMO-POS C-SNP) | UnitedHealthcare Benefits of Texas, Inc. | T1 | No | $0 | OR |
| UHC Complete Care WA-13 (HMO-POS C-SNP) | UnitedHealthcare Benefits of Texas, Inc. | T1 | No | $0 | WA |
| UHC Complete Care TX-2P (HMO-POS C-SNP) | Unitedhealthcare Community Plan OF Texas, L.L.C. | T1 | No | $0 | TX |
| UHC Complete Care TX-16 (HMO-POS C-SNP) | Physicians Health Choice OF Texas, LLC | T1 | No | $0 | TX |
| UHC Complete Care TX-17 (HMO-POS C-SNP) | Physicians Health Choice OF Texas, LLC | T1 | No | $0 | TX |
| UHC Complete Care TX-18 (HMO-POS C-SNP) | Physicians Health Choice OF Texas, LLC | T1 | No | $0 | TX |
| UHC Complete Care TX-19 (HMO-POS C-SNP) | Physicians Health Choice OF Texas, LLC | T1 | No | $0 | TX |
| UHC Complete Care UT-6 (HMO-POS C-SNP) | Unitedhealthcare OF THE Rockies, Inc. | T1 | No | $0 | UT |
| UHC Complete Care ID-12 (HMO-POS C-SNP) | Unitedhealthcare OF THE Rockies, Inc. | T1 | No | $0 | ID |
| UHC Complete Care ID-13 (HMO-POS C-SNP) | Unitedhealthcare OF THE Rockies, Inc. | T1 | No | $0 | ID |
| UHC Complete Care MA-7 (HMO-POS C-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T1 | No | $0 | MA |
| UHC Complete Care ME-6 (HMO-POS C-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T1 | No | $0 | ME |
| UHC Complete Care RI-4 (HMO-POS C-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T1 | No | $0 | RI |
| UHC Complete Care OK-8 (HMO-POS C-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T1 | No | $0 | OK |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is prasugrel 5 MG Oral Tablet covered by Medicare Part D?
Yes, prasugrel 5 MG Oral Tablet is covered by 4,973 Medicare Part D plans (98.4% of all Part D formularies).
What tier is prasugrel 5 MG Oral Tablet on Medicare Part D plans?
prasugrel 5 MG Oral Tablet averages Tier 2.3 across Part D plans, ranging from Tier 1 to Tier 4.
Does prasugrel 5 MG Oral Tablet require prior authorization?
0% of Part D formularies require prior authorization for prasugrel 5 MG Oral Tablet. Step therapy: 0%. Quantity limits: 37.3%.
How much does Medicare spend on prasugrel 5 MG Oral Tablet?
In 2023, total Medicare Part D spending on prasugrel 5 MG Oral Tablet was $30,426,210, covering 85,432 beneficiaries. The average spend per beneficiary was $356.15.
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
- 0.5 ML Haemophilus influenzae b (Ross strain) capsular polysaccharide meningococcal protein conjugate vaccine 0.265 MG/ML Injection [PedvaxHIB] T2.3
- morphine sulfate 15 MG Extended Release Oral Tablet T2.3
- trifluoperazine 1 MG Oral Tablet T2.3
- sulfamethoxazole 40 MG/ML / trimethoprim 8 MG/ML Oral Suspension T2.3
- benazepril hydrochloride 5 MG / hydrochlorothiazide 6.25 MG Oral Tablet T2.3
- bacitracin zinc 0.4 UNT/MG / hydrocortisone acetate 0.01 MG/MG / neomycin sulfate 0.0035 MG/MG / polymyxin B sulfate 10 UNT/MG Ophthalmic Ointment T2.3
Similar prior-authorization rate
- metronidazole 10 MG/ML Topical Cream [Noritate] 0% PA
- 24 HR minocycline 40 MG Extended Release Oral Capsule [Emrosi] 0% PA
- buspirone hydrochloride 10 MG Oral Capsule [Bucapsol] 0% PA
- diflunisal 375 MG Oral Tablet [Dolobid] 0% PA
- hydrocortisone 1 MG/ML Oral Solution [Khindivi] 0% PA
- indomethacin 50 MG Rectal Suppository [Indocin] 0% PA