Medicare Part D coverage · ticagrelor · RxCUI 1666334
ticagrelor 60 MG Oral Tablet [Brilinta]
Per the CMS 2026 Part D formulary file, ticagrelor 60 MG Oral Tablet [Brilinta] is covered by 61 Medicare Part D plans (1.2% of enrollable products), averaging Tier 2.8, with prior authorization required on 0% of covering formularies.
- 1.2%
- Plan coverage
- 61
- Plans covering
- T2.8
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for ticagrelor 60 MG Oral Tablet [Brilinta]
Per the CMS 2026 Part D formulary file, ticagrelor 60 MG Oral Tablet [Brilinta] (RxNorm concept RXCUI 1666334, generic name ticagrelor) appears on 9 distinct formulary files spanning 61 Medicare Part D plan offerings - 1.2% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.8.
Real-world access to ticagrelor 60 MG Oral Tablet [Brilinta] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 11.1% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 234,770 Part D beneficiaries filled ticagrelor 60 MG Oral Tablet [Brilinta] in 2023, with total plan-and-beneficiary spending of $691,725,954 and an average per-beneficiary annual cost of $2,946.40. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry ticagrelor 60 MG Oral Tablet [Brilinta] today.
Coverage Details
- Formularies covering
- 9
- Plans covering
- 61
- Coverage rate
- 1.2%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 11.1% of formularies
2023 Medicare Spending
- Beneficiaries
- 234,770
- Total spending
- $691,725,954
- Avg per beneficiary
- $2,946.40
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering ticagrelor 60 MG Oral Tablet [Brilinta]
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Prescription Blue Select (PDP) | Bcbs OF Michigan Mutual Insurance Company | T4 | No | No | $78.40 | - |
| Prescription Blue Premium (PDP) | Bcbs OF Michigan Mutual Insurance Company | T4 | No | No | $106.70 | - |
Medicare Advantage Plans (MA-PD) Covering ticagrelor 60 MG Oral Tablet [Brilinta]
59 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $0 | NY |
| Hamaspik Medicare Select (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $34.50 | NY |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T2 | No | $0 | CA |
| Health New England Medicare Compass (PPO) | Health NEW England, Inc. | T3 | No | $0 | MA |
| Health New England Medicare Value (HMO) | Health NEW England, Inc. | T3 | No | $0 | MA |
| Health First Rewards H1099-014 (HMO) | Health First Health Plans | T3 | No | $0 | FL |
| Health First SunSaver H1099-016 (HMO) | Health First Health Plans | T3 | No | $0 | FL |
| Health First Complete Care H1099-023 (HMO) | Health First Health Plans | T3 | No | $0 | FL |
| Health First Emerald Plus H1099-024 (HMO) | Health First Health Plans | T3 | No | $0 | FL |
| Health First Premier Access H1099-025 (HMO-POS) | Health First Health Plans | T3 | No | $0 | FL |
| Health First Emerald Plus H1099-026 (HMO) | Health First Health Plans | T3 | No | $0 | FL |
| Health First Premier Access H1099-027 (HMO-POS) | Health First Health Plans | T3 | No | $0 | FL |
| Health First Emerald Plus H1099-028 (HMO) | Health First Health Plans | T3 | No | $0 | FL |
| Prominence Plus (HMO) | Prominence Healthfirst | T3 | No | $0 | NV |
| Prominence Plus (HMO) | Prominence Healthfirst | T3 | No | $0 | NV |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst | T3 | No | $0 | NV |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst | T3 | No | $0 | NV |
| Prominence Giveback (HMO) | Prominence Healthfirst | T3 | No | $0 | NV |
| Prominence Plus (HMO) | Prominence Healthfirst OF Florida Inc | T3 | No | $0 | FL |
| Prominence Giveback (HMO) | Prominence Healthfirst OF Florida Inc | T3 | No | $0 | FL |
Show the next 30 plans
| Prominence Plus (HMO) | Prominence Healthfirst OF Texas | T3 | No | $0 | TX |
| Prominence Plus (HMO) | Prominence Healthfirst OF Texas | T3 | No | $0 | TX |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst OF Texas | T3 | No | $0 | TX |
| Prominence Extra Help (HMO) | Prominence Healthfirst OF Texas | T3 | No | $0 | TX |
| Prominence Beyond (HMO) | Prominence Healthfirst OF Texas | T3 | No | $0 | TX |
| Prominence Giveback (HMO) | Prominence Healthfirst OF Texas | T3 | No | $0 | TX |
| Prominence Giveback (HMO) | Prominence Healthfirst OF Texas | T3 | No | $0 | TX |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst OF Texas | T3 | No | $0 | TX |
| Prominence Beyond (HMO-POS) | Prominence Healthfirst OF Texas | T3 | No | $0 | TX |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst OF Florida Inc | T3 | No | $0 | FL |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst | T3 | No | $0 | NV |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst OF Florida Inc | T3 | No | $0 | FL |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst OF Texas | T3 | No | $0 | TX |
| Prominence Diabetes and Heart Care Plus (HMO C-SNP) | Prominence Healthfirst OF Texas | T3 | No | $0 | TX |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst OF Texas | T3 | No | $0 | TX |
| Prominence Extra Help (HMO) | Prominence Healthfirst | T3 | No | $4.20 | NV |
| Prominence Extra Help (HMO) | Prominence Healthfirst OF Florida Inc | T3 | No | $4.80 | FL |
| Prominence Extra Help (HMO) | Prominence Healthfirst OF Texas | T3 | No | $4.80 | TX |
| Prominence Extra Help (HMO) | Prominence Healthfirst | T3 | No | $9.50 | NV |
| Health First Value H1099-006 (HMO) | Health First Health Plans | T3 | No | $15.00 | FL |
| Health New England Medicare Premium (HMO) | Health NEW England, Inc. | T3 | No | $15.80 | MA |
| Health First Classic H1099-001 (HMO-POS) | Health First Health Plans | T3 | No | $49.40 | FL |
| Health New England Medicare Plus (HMO) | Health NEW England, Inc. | T3 | No | $58.40 | MA |
| BCN Advantage ConnectedCare (HMO) | Blue Care Network OF Michigan | T4 | No | $0 | MI |
| Medicare Plus Blue Essential (PPO) | Bcbs OF Michigan Mutual Insurance Company | T4 | No | $0 | MI |
| Medicare Plus Blue + Meijer (PPO) | Bcbs OF Michigan Mutual Insurance Company | T4 | No | $0 | MI |
| Medicare Plus Blue Giveback (PPO) | Bcbs OF Michigan Mutual Insurance Company | T4 | No | $0 | MI |
| Medicare Plus Blue Secure (PPO) | Bcbs OF Michigan Mutual Insurance Company | T4 | No | $0 | MI |
| Medicare Plus Blue Value (PPO) | Bcbs OF Michigan Mutual Insurance Company | T4 | No | $0 | MI |
| BCN Advantage Prime Value (HMO-POS) | Blue Care Network OF Michigan | T4 | No | $9.60 | MI |
Showing top 50 of 59 plans.
Frequently Asked Questions
Is ticagrelor 60 MG Oral Tablet [Brilinta] covered by Medicare Part D?
Yes, ticagrelor 60 MG Oral Tablet [Brilinta] is covered by 61 Medicare Part D plans (1.2% of all Part D formularies).
What tier is ticagrelor 60 MG Oral Tablet [Brilinta] on Medicare Part D plans?
ticagrelor 60 MG Oral Tablet [Brilinta] averages Tier 2.8 across Part D plans, ranging from Tier 1 to Tier 4.
Does ticagrelor 60 MG Oral Tablet [Brilinta] require prior authorization?
0% of Part D formularies require prior authorization for ticagrelor 60 MG Oral Tablet [Brilinta]. Step therapy: 0%. Quantity limits: 11.1%.
How much does Medicare spend on ticagrelor 60 MG Oral Tablet [Brilinta]?
In 2023, total Medicare Part D spending on ticagrelor 60 MG Oral Tablet [Brilinta] was $691,725,954, covering 234,770 beneficiaries. The average spend per beneficiary was $2,946.40.
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
Similar prior-authorization rate
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