ticagrelor 90 MG Oral Tablet [Brilinta]
ticagrelor
RxCUI: 1116639
What the CMS Formulary Data Shows for ticagrelor 90 MG Oral Tablet [Brilinta]
Per the CMS 2026 Part D formulary file, ticagrelor 90 MG Oral Tablet [Brilinta] (RxNorm concept RXCUI 1116639, generic name ticagrelor) appears on 72 distinct formulary files spanning 237 Medicare Part D plan offerings - 4.7% 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 2.6.
Real-world access to ticagrelor 90 MG Oral Tablet [Brilinta] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 234,770 Part D beneficiaries filled ticagrelor 90 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 90 MG Oral Tablet [Brilinta] today.
Coverage Details
- Formularies covering
- 72
- Plans covering
- 237
- Coverage rate
- 4.7%
- 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
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 234,770
- Total spending
- $691,725,954
- Avg per beneficiary
- $2,946.40
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering ticagrelor 90 MG Oral Tablet [Brilinta]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | SENTARA HEALTH PLANS | T1 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | SENTARA HEALTH PLANS | T1 | No | $0 | VA |
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | ALAMEDA ALLIANCE FOR HEALTH | T1 | No | $0 | CA |
| Elevate Medicare Choice (HMO D-SNP) | DENVER HEALTH MEDICAL PLAN, INC. | T1 | No | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | ALLCARE HEALTH PLAN, INC. | T1 | No | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE | T1 | No | $0 | MN |
| Prime Health Complete (HMO D-SNP) | PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE | T1 | No | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | ALTERWOOD ADVANTAGE, INC. | T1 | No | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK | T1 | No | $0 | NY |
| Abilis Health Community (HMO I-SNP) | SIGNATURE ADVANTAGE, LLC | T1 | No | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | ARKANSAS SUPERIOR SELECT, INC. | T1 | No | $0 | AR |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T1 | No | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | TEXAS INDEPENDENCE HEALTH PLAN, INC. | T1 | No | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | TEXAS INDEPENDENCE HEALTH PLAN, INC. | T1 | No | $4.80 | TX |
| Tribute Select (HMO-POS I-SNP) | ARKANSAS SUPERIOR SELECT, INC. | T1 | No | $8.90 | AR |
| ATRIO Special Needs Plan (HMO D-SNP) | ATRIO HEALTH PLANS | T1 | No | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | ATRIO HEALTH PLANS | T1 | No | $10.50 | OR |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T1 | No | $17.00 | AZ |
| Alterwood Advantage Dual Value (HMO D-SNP) | ALTERWOOD ADVANTAGE, INC. | T1 | No | $31.20 | MD |
| Valor Health Plan (HMO I-SNP) | TSG GUARD, INC. | T1 | No | $31.40 | OH |
| WV Senior Advantage (HMO I-SNP) | WEST VIRGINIA SENIOR ADVANTAGE, INC. | T1 | No | $32.70 | WV |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $34.50 | NY |
| Abilis Health (HMO I-SNP) | SIGNATURE ADVANTAGE, LLC | T1 | No | $35.90 | KY, TN |
| CommuniCare Advantage ISNP (HMO I-SNP) | OH CHS SNP INC. | T1 | No | $38.40 | IN, MD, OH |
| Nascentia Skilled Nursing Facility (HMO I-SNP) | VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK | T1 | No | $58.80 | NY |
| BlueCare Plus (HMO D-SNP) | VOLUNTEER STATE HEALTH PLAN | T2 | No | $0 | TN |
| BlueCare Plus Choice (HMO D-SNP) | VOLUNTEER STATE HEALTH PLAN | T2 | No | $0 | TN |
| BlueCare Plus Select (HMO D-SNP) | VOLUNTEER STATE HEALTH PLAN | T2 | No | $0 | TN |
| PHP (HMO C-SNP) | AIDS HEALTHCARE FOUNDATION | T2 | No | $0 | CA |
| DualConnect (HMO D-SNP) | SANTA CLARA COUNTY HEALTH AUTHORITY | T2 | No | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS CHOICE | T2 | No | $0 | NY |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS CHOICE | T2 | No | $51.60 | NY |
| BlueAdvantage Sapphire (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T3 | No | $0 | TN |
| BlueAdvantage Sapphire (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T3 | No | $0 | TN |
| BlueAdvantage Garnet (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T3 | No | $0 | TN |
| BlueAdvantage Garnet (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T3 | No | $0 | TN |
| BlueAdvantage Sapphire (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T3 | No | $0 | TN |
| BlueAdvantage Sapphire (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T3 | No | $0 | GA |
| BlueAdvantage Total Heart and Diabetes (PPO C-SNP) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T3 | No | $0 | GA, TN |
| BlueAdvantage Total Heart and Diabetes (PPO C-SNP) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T3 | No | $0 | TN |
| Personal Choice 65 Achieve Rx (PPO) | QCC INSURANCE COMPANY | T3 | No | $0 | PA |
| Keystone 65 Focus Rx (HMO-POS) | KEYSTONE HEALTH PLAN EAST, INC. | T3 | No | $0 | PA |
| Keystone 65 Focus Rx (HMO-POS) | KEYSTONE HEALTH PLAN EAST, INC. | T3 | No | $0 | PA |
| Keystone 65 Basic Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T3 | No | $0 | PA |
| AmeriHealth Medicare Core (PPO) | AMERIHEALTH INSURANCE COMPANY OF NEW JERSEY | T3 | No | $0 | NJ |
| AmeriHealth Medicare Ultimate (PPO) | AMERIHEALTH INSURANCE COMPANY OF NEW JERSEY | T3 | No | $0 | NJ |
| Health New England Medicare Compass (PPO) | HEALTH NEW ENGLAND, INC. | T3 | No | $0 | MA |
Frequently Asked Questions
Is ticagrelor 90 MG Oral Tablet [Brilinta] covered by Medicare Part D?
Yes, ticagrelor 90 MG Oral Tablet [Brilinta] is covered by 237 Medicare Part D plans (4.7% of all Part D formularies).
What tier is ticagrelor 90 MG Oral Tablet [Brilinta] on Medicare Part D plans?
ticagrelor 90 MG Oral Tablet [Brilinta] averages Tier 2.6 across Part D plans, ranging from Tier 1 to Tier 4.
Does ticagrelor 90 MG Oral Tablet [Brilinta] require prior authorization?
0% of Part D formularies require prior authorization for ticagrelor 90 MG Oral Tablet [Brilinta]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on ticagrelor 90 MG Oral Tablet [Brilinta]?
In 2023, total Medicare Part D spending on ticagrelor 90 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.