sumatriptan 11 MG Nasal Powder [Onzetra]
sumatriptan
RxCUI: 1739337
What the CMS Formulary Data Shows for sumatriptan 11 MG Nasal Powder [Onzetra]
Per the CMS 2026 Part D formulary file, sumatriptan 11 MG Nasal Powder [Onzetra] (RxNorm concept RXCUI 1739337, generic name sumatriptan) appears on 1 distinct formulary file spanning 10 Medicare Part D plan offerings - 0.2% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 4 to Tier 4, with a cross-plan average of Tier 4.
Real-world access to sumatriptan 11 MG Nasal Powder [Onzetra] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 100% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 13,833 Part D beneficiaries filled sumatriptan 11 MG Nasal Powder [Onzetra] in 2023, with total plan-and-beneficiary spending of $10,832,608 and an average per-beneficiary annual cost of $783.10. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry sumatriptan 11 MG Nasal Powder [Onzetra] today.
Coverage Details
- Formularies covering
- 1
- Plans covering
- 10
- Coverage rate
- 0.2%
- Tier range
- Tier 4, Non-Preferred
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 100% of formularies
2023 Medicare Spending
- Beneficiaries
- 13,833
- Total spending
- $10,832,608
- Avg per beneficiary
- $783.10
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering sumatriptan 11 MG Nasal Powder [Onzetra]
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP) | HM HEALTH INSURANCE COMPANY | T4 | No | No | $164.80 | - |
| Blue Rx PDP Plus (PDP) | HM HEALTH INSURANCE COMPANY | T4 | No | No | $193.20 | - |
Medicare Advantage Plans (MA-PD) Covering sumatriptan 11 MG Nasal Powder [Onzetra]
8 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Security Blue HMO-POS Standard (HMO-POS) | HIGHMARK CHOICE COMPANY | T4 | No | $51.80 | PA |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $95.70 | PA |
| Security Blue HMO-POS Deluxe (HMO-POS) | HIGHMARK CHOICE COMPANY | T4 | No | $95.90 | PA |
| Freedom Blue PPO Standard (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $98.20 | PA |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $115.70 | PA |
| Freedom Blue PPO Deluxe (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $122.40 | PA |
| Freedom Blue PPO Classic (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $140.90 | PA |
| Freedom Blue PPO Classic (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $145.40 | PA |
Frequently Asked Questions
Is sumatriptan 11 MG Nasal Powder [Onzetra] covered by Medicare Part D?
Yes, sumatriptan 11 MG Nasal Powder [Onzetra] is covered by 10 Medicare Part D plans (0.2% of all Part D formularies).
What tier is sumatriptan 11 MG Nasal Powder [Onzetra] on Medicare Part D plans?
sumatriptan 11 MG Nasal Powder [Onzetra] averages Tier 4 across Part D plans, ranging from Tier 4 to Tier 4.
Does sumatriptan 11 MG Nasal Powder [Onzetra] require prior authorization?
0% of Part D formularies require prior authorization for sumatriptan 11 MG Nasal Powder [Onzetra]. Step therapy: 0%. Quantity limits: 100%.
How much does Medicare spend on sumatriptan 11 MG Nasal Powder [Onzetra]?
In 2023, total Medicare Part D spending on sumatriptan 11 MG Nasal Powder [Onzetra] was $10,832,608, covering 13,833 beneficiaries. The average spend per beneficiary was $783.10.
Read our methodology - how this data is sourced, computed, and verified.