Medicare Part D coverage · sumatriptan · RxCUI 2178073
sumatriptan 10 MG/ACTUAT Nasal Spray [Tosymra]
Per the CMS 2026 Part D formulary file, sumatriptan 10 MG/ACTUAT Nasal Spray [Tosymra] is covered by 12 Medicare Part D plans (0.2% of enrollable products), averaging Tier 4, with prior authorization required on 0% of covering formularies.
- 0.2%
- Plan coverage
- 12
- Plans covering
- T4
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for sumatriptan 10 MG/ACTUAT Nasal Spray [Tosymra]
Per the CMS 2026 Part D formulary file, sumatriptan 10 MG/ACTUAT Nasal Spray [Tosymra] (RxNorm concept RXCUI 2178073, generic name sumatriptan) appears on 1 distinct formulary file spanning 12 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 10 MG/ACTUAT Nasal Spray [Tosymra] 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 10 MG/ACTUAT Nasal Spray [Tosymra] 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 10 MG/ACTUAT Nasal Spray [Tosymra] today.
Coverage Details
- Formularies covering
- 1
- Plans covering
- 12
- 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
Medicare Advantage Plans (MA-PD) Covering sumatriptan 10 MG/ACTUAT Nasal Spray [Tosymra]
12 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| HAP Medicare Explore (PPO) | Alliance Health AND Life Insurance Company | T4 | No | $0 | MI |
| HAP Medicare Prime (PPO) | Alliance Health AND Life Insurance Company | T4 | No | $0 | MI |
| HAP Medicare Connect (HMO) | Health Alliance Plan OF Michigan | T4 | No | $0 | MI |
| HAP Medicare Complete Duals (HMO D-SNP) | Health Alliance Plan OF Michigan | T4 | No | $0 | MI |
| HAP Medicare Superior (HMO) | Health Alliance Plan OF Michigan | T4 | No | $0 | MI |
| Henry Ford Select (HMO) | Health Alliance Plan OF Michigan | T4 | No | $0 | MI |
| HAP Member Assist (PPO) | Alliance Health AND Life Insurance Company | T4 | No | $8.80 | MI |
| HAP Medicare Complete Assist (PPO D-SNP) | Alliance Health AND Life Insurance Company | T4 | No | $8.80 | MI |
| HAP Medicare Diabetes and Heart (HMO C-SNP) | Health Alliance Plan OF Michigan | T4 | No | $8.80 | MI |
| HAP Senior Plus Henry Ford Tiered Access (HMO) | Health Alliance Plan OF Michigan | T4 | No | $11.30 | MI |
| HAP Senior Plus (HMO-POS) | Health Alliance Plan OF Michigan | T4 | No | $13.50 | MI |
| HAP Senior Plus (PPO) | Alliance Health AND Life Insurance Company | T4 | No | $42.60 | MI |
Frequently Asked Questions
Is sumatriptan 10 MG/ACTUAT Nasal Spray [Tosymra] covered by Medicare Part D?
Yes, sumatriptan 10 MG/ACTUAT Nasal Spray [Tosymra] is covered by 12 Medicare Part D plans (0.2% of all Part D formularies).
What tier is sumatriptan 10 MG/ACTUAT Nasal Spray [Tosymra] on Medicare Part D plans?
sumatriptan 10 MG/ACTUAT Nasal Spray [Tosymra] averages Tier 4 across Part D plans, ranging from Tier 4 to Tier 4.
Does sumatriptan 10 MG/ACTUAT Nasal Spray [Tosymra] require prior authorization?
0% of Part D formularies require prior authorization for sumatriptan 10 MG/ACTUAT Nasal Spray [Tosymra]. Step therapy: 0%. Quantity limits: 100%.
How much does Medicare spend on sumatriptan 10 MG/ACTUAT Nasal Spray [Tosymra]?
In 2023, total Medicare Part D spending on sumatriptan 10 MG/ACTUAT Nasal Spray [Tosymra] 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.
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
- dihydroergotamine mesylate 0.5 MG/ACTUAT Metered Dose Nasal Spray T4
- 0.5 ML darbepoetin alfa 0.2 MG/ML Prefilled Syringe [Aranesp] T4
- amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia] T4
- timolol hemihydrate 5 MG/ML Ophthalmic Solution [Betimol] T4
- deflazacort 18 MG Oral Tablet [Jaythari] T4
- bepotastine besilate 15 MG/ML Ophthalmic Solution [Bepreve] T4