sildenafil 10 MG/ML Oral Suspension

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sildenafil

RxCUI: 1307427

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.
4.2%
Plan Coverage
213
Plans Covering
T3.7
Avg Tier
100%
Prior Auth Required

What the CMS Formulary Data Shows for sildenafil 10 MG/ML Oral Suspension

Per the CMS 2026 Part D formulary file, sildenafil 10 MG/ML Oral Suspension (RxNorm concept RXCUI 1307427, generic name sildenafil) appears on 30 distinct formulary files spanning 213 Medicare Part D plan offerings - 4.2% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 3.7.

Real-world access to sildenafil 10 MG/ML Oral Suspension depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 66.7% apply quantity limits.

Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 253,277 Part D beneficiaries filled sildenafil 10 MG/ML Oral Suspension in 2023, with total plan-and-beneficiary spending of $44,729,269 and an average per-beneficiary annual cost of $176.60. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry sildenafil 10 MG/ML Oral Suspension today.

Coverage Details

Formularies covering
30
Plans covering
213
Coverage rate
4.2%
Tier range
Tier 1 – Tier 6
Average tier
Tier 4, Non-Preferred

Restrictions

Prior authorization required
100% of formularies
Step therapy required
0% of formularies
Quantity limits
66.7% of formularies

2023 Medicare Spending

Beneficiaries
253,277
Total spending
$44,729,269
Avg per beneficiary
$176.60

Tier Distribution Across Plans

6 plans
Tier 1, Preferred Generic
94 plans
Tier 2, Generic

Medicare Advantage Plans (MA-PD) Covering sildenafil 10 MG/ML Oral Suspension

100 Medicare Advantage plans with Part D drug coverage include this drug.

Plan Insurer Tier PA Premium States
SeniorCare Complete (HMO D-SNP) SOUTH COUNTRY HEALTH ALLIANCE T1 Yes $0 MN
AbilityCare (HMO D-SNP) SOUTH COUNTRY HEALTH ALLIANCE T1 Yes $0 MN
Alameda Alliance Wellness (HMO D-SNP) ALAMEDA ALLIANCE FOR HEALTH T1 Yes $0 CA
CalOptima Health OneCare Complete (HMO D-SNP) ORANGE COUNTY HEALTH AUTHORITY T1 Yes $0 CA
Mass General Brigham SCO (HMO D-SNP) MASS GENERAL BRIGHAM HEALTH PLAN, INC T1 Yes $0 MA
Mass General Brigham One Care (HMO D-SNP) MASS GENERAL BRIGHAM HEALTH PLAN, INC T1 Yes $0 MA
Healthy Mississippi Premier Advantage (HMO-POS) Healthy Mississippi, Inc. T2 Yes $0 MS
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage Enhanced Solano (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage Inland Empire (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage Ventura (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage Enhanced Kern (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage Basic Kern (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage San Diego (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage Basic Stanis (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage Basic Fresno (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage Santa Cruz (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage Basic Alameda (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage Basic SF (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage Basic Solano (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Sr Advantage Inland Empire Value (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage San Diego Value (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage Ventura Value (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 CA
Kaiser Permanente Senior Advantage Core DM (HMO) KAISER FOUNDATION HP OF CO T2 Yes $0 CO
Kaiser Permanente Dual Essential (HMO D-SNP) KAISER FOUNDATION HP OF CO T2 Yes $0 CO
Kaiser Permanente Senior Advantage Silver DM (HMO-POS) KAISER FOUNDATION HP OF CO T2 Yes $0 CO
Kaiser Permanente Senior Advantage Core South (HMO) KAISER FOUNDATION HP OF CO T2 Yes $0 CO
Kaiser Permanente Senior Advantage Core North (HMO) KAISER FOUNDATION HP OF CO T2 Yes $0 CO
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) KAISER FOUNDATION HP OF CO T2 Yes $0 CO
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) KAISER FOUNDATION HP OF CO T2 Yes $0 CO
Kaiser Permanente Senior Advantage Bronze DM (HMO-POS) KAISER FOUNDATION HP OF CO T2 Yes $0 CO
Kaiser Permanente Dual Complete (HMO D-SNP) KAISER FOUNDATION HP OF CO T2 Yes $0 CO
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) KAISER FOUNDATION HP OF GA, INC. T2 Yes $0 GA
Kaiser Permanente Senior Advantage Basic 1 (HMO) KAISER FOUNDATION HP OF GA, INC. T2 Yes $0 GA
Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP) KAISER FOUNDATION HP OF GA, INC. T2 Yes $0 GA
Kaiser Permanente Senior Advantage Basic 2 (HMO) KAISER FOUNDATION HP OF GA, INC. T2 Yes $0 GA
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) KAISER FOUNDATION HP OF GA, INC. T2 Yes $0 GA
Kaiser Permanente Dual Complete (HMO D-SNP) KAISER FOUNDATION HP OF GA, INC. T2 Yes $0 GA
Kaiser Permanente Senior Advantage Basic (HMO) KAISER FOUNDATION HP, INC. T2 Yes $0 HI
Kaiser Permanente Medicare Advantage Value 1 VA (HMO-POS) KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES T2 Yes $0 VA
Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP) KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES T2 Yes $0 MD

Frequently Asked Questions

Is sildenafil 10 MG/ML Oral Suspension covered by Medicare Part D?

Yes, sildenafil 10 MG/ML Oral Suspension is covered by 213 Medicare Part D plans (4.2% of all Part D formularies).

What tier is sildenafil 10 MG/ML Oral Suspension on Medicare Part D plans?

sildenafil 10 MG/ML Oral Suspension averages Tier 3.7 across Part D plans, ranging from Tier 1 to Tier 6.

Does sildenafil 10 MG/ML Oral Suspension require prior authorization?

100% of Part D formularies require prior authorization for sildenafil 10 MG/ML Oral Suspension. Step therapy: 0%. Quantity limits: 66.7%.

How much does Medicare spend on sildenafil 10 MG/ML Oral Suspension?

In 2023, total Medicare Part D spending on sildenafil 10 MG/ML Oral Suspension was $44,729,269, covering 253,277 beneficiaries. The average spend per beneficiary was $176.60.

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