Medicare Part D coverage · risperidone · RxCUI 312828
risperidone 0.25 MG Oral Tablet
Per the CMS 2026 Part D formulary file, risperidone 0.25 MG Oral Tablet is covered by 5,052 Medicare Part D plans (100% of enrollable products), averaging Tier 1.5, with prior authorization required on 0% of covering formularies.
- 100%
- Plan coverage
- 5,052
- Plans covering
- T1.5
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for risperidone 0.25 MG Oral Tablet
Per the CMS 2026 Part D formulary file, risperidone 0.25 MG Oral Tablet (RxNorm concept RXCUI 312828, generic name risperidone) 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 3, with a cross-plan average of Tier 1.5.
Real-world access to risperidone 0.25 MG Oral Tablet depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 46.6% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 478,904 Part D beneficiaries filled risperidone 0.25 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $60,762,873 and an average per-beneficiary annual cost of $126.88. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry risperidone 0.25 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 328
- Plans covering
- 5,052
- Coverage rate
- 100%
- Tier range
- Tier 1 – Tier 3
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 46.6% of formularies
2023 Medicare Spending
- Beneficiaries
- 478,904
- Total spending
- $60,762,873
- Avg per beneficiary
- $126.88
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering risperidone 0.25 MG Oral Tablet
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
Show the next 30 plans
| 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 |
| 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 |
| 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 |
| Freedom Máximo (HMO-POS) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Máximo (HMO-POS) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Platinum Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Gold Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Savings COPD (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Gold Plus Plan (HMO) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | No | $0 | FL |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | No | $0 | NY |
| The Health Plan SecureCare - Option II (HMO) | THE Health Plan OF West Virginia, Inc. | T1 | No | $0 | OH |
| The Health Plan SecureCare - Option II (HMO) | THE Health Plan OF West Virginia, Inc. | T1 | No | $0 | OH, WV |
| The Health Plan SecureCare Capitol Plan (HMO) | THE Health Plan OF West Virginia, Inc. | T1 | No | $0 | WV |
| The Health Plan SecureChoice Optimum (PPO) | THP Insurance Company | T1 | No | $0 | OH, WV |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| WellSense Signature (HMO) | Boston Medical Center Health Plan, Inc. | T1 | No | $0 | NH |
| WellSense Signature Access (PPO) | Boston Medical Center Health Plan, Inc. | T1 | No | $0 | NH |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is risperidone 0.25 MG Oral Tablet covered by Medicare Part D?
Yes, risperidone 0.25 MG Oral Tablet is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).
What tier is risperidone 0.25 MG Oral Tablet on Medicare Part D plans?
risperidone 0.25 MG Oral Tablet averages Tier 1.5 across Part D plans, ranging from Tier 1 to Tier 3.
Does risperidone 0.25 MG Oral Tablet require prior authorization?
0% of Part D formularies require prior authorization for risperidone 0.25 MG Oral Tablet. Step therapy: 0%. Quantity limits: 46.6%.
How much does Medicare spend on risperidone 0.25 MG Oral Tablet?
In 2023, total Medicare Part D spending on risperidone 0.25 MG Oral Tablet was $60,762,873, covering 478,904 beneficiaries. The average spend per beneficiary was $126.88.
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
- amiodarone hydrochloride 200 MG Oral Tablet T1.5
- doxazosin 1 MG Oral Tablet T1.5
- levocetirizine dihydrochloride 5 MG Oral Tablet T1.5
- bisoprolol fumarate 10 MG / hydrochlorothiazide 6.25 MG Oral Tablet T1.5
- hydrocortisone 10 MG/ML Topical Cream T1.5
- timolol hemihydrate 5 MG/ML Ophthalmic Solution T1.5
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