Medicare Part D coverage · quetiapine · RxCUI 312744
quetiapine 25 MG Oral Tablet
Per the CMS 2026 Part D formulary file, quetiapine 25 MG Oral Tablet is covered by 5,052 Medicare Part D plans (100% of enrollable products), averaging Tier 1.8, with prior authorization required on 13.4% of covering formularies.
- 100%
- Plan coverage
- 5,052
- Plans covering
- T1.8
- Avg tier
- 13.4%
- Prior auth required
What the CMS Formulary Data Shows for quetiapine 25 MG Oral Tablet
Per the CMS 2026 Part D formulary file, quetiapine 25 MG Oral Tablet (RxNorm concept RXCUI 312744, generic name quetiapine) appears on 328 distinct formulary files spanning 5,052 Medicare Part D plan offerings - 100% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 1.8.
Real-world access to quetiapine 25 MG Oral Tablet depends on utilization management as much as tier placement: 13.4% of covering formularies require prior authorization. 0% require step therapy. 65.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 1,335,528 Part D beneficiaries filled quetiapine 25 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $201,074,942 and an average per-beneficiary annual cost of $150.56. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry quetiapine 25 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 328
- Plans covering
- 5,052
- Coverage rate
- 100%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 13.4% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 65.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,335,528
- Total spending
- $201,074,942
- Avg per beneficiary
- $150.56
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering quetiapine 25 MG Oral Tablet
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Community Blue Medicare HMO Signature (HMO) | Highmark Western and Northeastern New York Inc. | T1 | No | $0 | NY |
| Community Blue Medicare HMO Merit (HMO) | Highmark Western and Northeastern New York Inc. | T1 | No | $0 | NY |
| Community Blue Medicare PPO Signature (PPO) | Highmark Senior Health Company | T1 | No | $0 | PA |
| Complete Blue PPO Signature (PPO) | Highmark Senior Health Company | T1 | No | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | Highmark Senior Health Company | T1 | No | $0 | PA |
| Complete Blue PPO Signature (PPO) | Highmark Senior Health Company | T1 | No | $0 | PA |
| Complete Blue PPO Merit (PPO) | Highmark Senior Health Company | T1 | No | $0 | PA |
| Complete Blue PPO Signature (PPO) | Highmark Senior Health Company | T1 | No | $0 | PA |
| Complete Blue PPO Distinct (PPO) | Highmark Senior Health Company | T1 | No | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | Highmark Senior Health Company | T1 | No | $0 | PA |
| Complete Blue Plus PPO Merit (PPO) | Highmark Senior Health Company | T1 | No | $0 | PA |
| Community Blue Medicare PPO Signature (PPO) | Highmark Senior Health Company | T1 | No | $0 | PA |
| Complete Blue PPO Merit (PPO) | Highmark Senior Health Company | T1 | No | $0 | PA |
| Community Blue Medicare HMO Signature (HMO) | Highmark Choice Company | T1 | No | $0 | PA |
| Security Blue HMO-POS ValueRx (HMO-POS) | Highmark Choice Company | T1 | No | $0 | PA |
| Community Blue Medicare HMO Signature (HMO) | Highmark Choice Company | T1 | No | $0 | PA |
| Together Blue Medicare HMO Signature (HMO) | Highmark Choice Company | T1 | No | $0 | PA |
| Community Blue Medicare HMO Distinct (HMO) | Highmark Choice Company | T1 | No | $0 | PA |
| Complete Blue HMO Distinct (HMO) | Highmark Choice Company | T1 | No | $0 | PA |
| Complete Blue PPO Distinct (PPO) | Highmark Senior Solutions Company | T1 | No | $0 | WV |
Show the next 30 plans
| Complete Blue PPO Signature (PPO) | Highmark Senior Solutions Company | T1 | No | $0 | WV |
| Complete Blue PPO Signature (PPO) | Highmark Senior Solutions Company | T1 | No | $0 | WV |
| Complete Blue PPO Merit (PPO) | Highmark Senior Solutions Company | T1 | No | $0 | WV |
| Complete Blue PPO Signature (PPO) | Highmark Bcbsd Inc. | T1 | No | $0 | DE |
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| Freedom VIP Care (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Savings (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Freedom Medi-Medi Partial (HMO D-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Medi-Medi Full (HMO D-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Optimum Emerald Partial (HMO D-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Emerald Full (HMO D-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is quetiapine 25 MG Oral Tablet covered by Medicare Part D?
Yes, quetiapine 25 MG Oral Tablet is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).
What tier is quetiapine 25 MG Oral Tablet on Medicare Part D plans?
quetiapine 25 MG Oral Tablet averages Tier 1.8 across Part D plans, ranging from Tier 1 to Tier 4.
Does quetiapine 25 MG Oral Tablet require prior authorization?
13.4% of Part D formularies require prior authorization for quetiapine 25 MG Oral Tablet. Step therapy: 0%. Quantity limits: 65.5%.
How much does Medicare spend on quetiapine 25 MG Oral Tablet?
In 2023, total Medicare Part D spending on quetiapine 25 MG Oral Tablet was $201,074,942, covering 1,335,528 beneficiaries. The average spend per beneficiary was $150.56.
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
- pimozide 2 MG Oral Tablet 13.4% PA
- pimozide 1 MG Oral Tablet 13.4% PA
- thiothixene 10 MG Oral Capsule 13.4% PA
- thiothixene 1 MG Oral Capsule 13.4% PA
- thiothixene 2 MG Oral Capsule 13.4% PA
- aripiprazole 15 MG Oral Tablet 13.4% PA