tapentadol 100 MG Oral Tablet [Nucynta]
tapentadol
RxCUI: 854140
What the CMS Formulary Data Shows for tapentadol 100 MG Oral Tablet [Nucynta]
Per the CMS 2026 Part D formulary file, tapentadol 100 MG Oral Tablet [Nucynta] (RxNorm concept RXCUI 854140, generic name tapentadol) 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 5 to Tier 5, with a cross-plan average of Tier 5.
Real-world access to tapentadol 100 MG Oral Tablet [Nucynta] depends on utilization management as much as tier placement: 100% 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 10,048 Part D beneficiaries filled tapentadol 100 MG Oral Tablet [Nucynta] in 2023, with total plan-and-beneficiary spending of $58,810,957 and an average per-beneficiary annual cost of $5,853.00. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry tapentadol 100 MG Oral Tablet [Nucynta] today.
Coverage Details
- Formularies covering
- 1
- Plans covering
- 10
- Coverage rate
- 0.2%
- Tier range
- Tier 5, Specialty
- Average tier
- Tier 5, Specialty
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 100% of formularies
2023 Medicare Spending
- Beneficiaries
- 10,048
- Total spending
- $58,810,957
- Avg per beneficiary
- $5,853.00
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering tapentadol 100 MG Oral Tablet [Nucynta]
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP) | HM HEALTH INSURANCE COMPANY | T5 | Yes | No | $164.80 | - |
| Blue Rx PDP Plus (PDP) | HM HEALTH INSURANCE COMPANY | T5 | Yes | No | $193.20 | - |
Medicare Advantage Plans (MA-PD) Covering tapentadol 100 MG Oral Tablet [Nucynta]
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 | T5 | Yes | $51.80 | PA |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $95.70 | PA |
| Security Blue HMO-POS Deluxe (HMO-POS) | HIGHMARK CHOICE COMPANY | T5 | Yes | $95.90 | PA |
| Freedom Blue PPO Standard (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $98.20 | PA |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $115.70 | PA |
| Freedom Blue PPO Deluxe (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $122.40 | PA |
| Freedom Blue PPO Classic (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $140.90 | PA |
| Freedom Blue PPO Classic (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $145.40 | PA |
Frequently Asked Questions
Is tapentadol 100 MG Oral Tablet [Nucynta] covered by Medicare Part D?
Yes, tapentadol 100 MG Oral Tablet [Nucynta] is covered by 10 Medicare Part D plans (0.2% of all Part D formularies).
What tier is tapentadol 100 MG Oral Tablet [Nucynta] on Medicare Part D plans?
tapentadol 100 MG Oral Tablet [Nucynta] averages Tier 5 across Part D plans, ranging from Tier 5 to Tier 5.
Does tapentadol 100 MG Oral Tablet [Nucynta] require prior authorization?
100% of Part D formularies require prior authorization for tapentadol 100 MG Oral Tablet [Nucynta]. Step therapy: 0%. Quantity limits: 100%.
How much does Medicare spend on tapentadol 100 MG Oral Tablet [Nucynta]?
In 2023, total Medicare Part D spending on tapentadol 100 MG Oral Tablet [Nucynta] was $58,810,957, covering 10,048 beneficiaries. The average spend per beneficiary was $5,853.00.
Read our methodology - how this data is sourced, computed, and verified.