Medicare Part D coverage · topiramate · RxCUI 205316
topiramate 15 MG Oral Capsule
Per the CMS 2026 Part D formulary file, topiramate 15 MG Oral Capsule is covered by 5,052 Medicare Part D plans (100% of enrollable products), averaging Tier 2.2, with prior authorization required on 7.9% of covering formularies.
- 100%
- Plan coverage
- 5,052
- Plans covering
- T2.2
- Avg tier
- 7.9%
- Prior auth required
What the CMS Formulary Data Shows for topiramate 15 MG Oral Capsule
Per the CMS 2026 Part D formulary file, topiramate 15 MG Oral Capsule (RxNorm concept RXCUI 205316, generic name topiramate) appears on 328 distinct formulary files spanning 5,052 Medicare Part D plan offerings - 100% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.2.
Real-world access to topiramate 15 MG Oral Capsule depends on utilization management as much as tier placement: 7.9% 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 644,196 Part D beneficiaries filled topiramate 15 MG Oral Capsule in 2023, with total plan-and-beneficiary spending of $56,440,596 and an average per-beneficiary annual cost of $87.61. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry topiramate 15 MG Oral Capsule today.
Coverage Details
- Formularies covering
- 328
- Plans covering
- 5,052
- Coverage rate
- 100%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 7.9% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 644,196
- Total spending
- $56,440,596
- Avg per beneficiary
- $87.61
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering topiramate 15 MG Oral Capsule
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| UHC Dual Complete IA-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T1 | No | $0 | IA |
| UHC Dual Complete MO-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T1 | No | $0 | MO |
| UHC Dual Complete NE-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T1 | No | $0 | NE |
| UHC Dual Complete KS-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T1 | No | $0 | KS |
| UHC Dual Complete MO-S3 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T1 | No | $0 | MO |
| UHC Dual Complete KS-Q1 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T1 | No | $0 | KS |
| UHC Dual Complete TN-S001 (HMO-POS D-SNP) | Unitedhealthcare Plan OF THE River Valley, Inc. | T1 | No | $0 | TN |
| UHC Dual Complete TN-Y001 (HMO-POS D-SNP) | Unitedhealthcare Plan OF THE River Valley, Inc. | T1 | No | $0 | TN |
| UHC Dual Complete TN-Y2 (HMO-POS D-SNP) | Unitedhealthcare Plan OF THE River Valley, Inc. | T1 | No | $0 | TN |
| AARP Medicare Advantage from UHC MI-0001 (PPO) | Unitedhealthcare Insurance Company | T1 | No | $0 | MI |
| UHC Dual Complete NM-Y1 (PPO D-SNP) | Unitedhealthcare Insurance Company | T1 | No | $0 | NM |
| UHC Dual Complete NM-S1 (PPO D-SNP) | Unitedhealthcare Insurance Company | T1 | No | $0 | NM |
| UHC Dual Complete NM-V1 (PPO D-SNP) | Unitedhealthcare Insurance Company | T1 | No | $0 | NM |
| UHC Dual Complete AZ-S001 (HMO-POS D-SNP) | Arizona Physicians IPA, Inc. | T1 | No | $0 | AZ |
| UHC Dual Complete AZ-Y001 (HMO-POS D-SNP) | Arizona Physicians IPA, Inc. | T1 | No | $0 | AZ |
| UHC Dual Complete VA-Y4 (PPO D-SNP) | Care Improvement Plus South Central Insurance Co. | T1 | No | $0 | VA |
| AARP Medicare Advantage from UHC AL-0001 (HMO-POS) | Unitedhealthcare OF THE Midlands, Inc. | T1 | No | $0 | AL |
| AARP Medicare Advantage from UHC CA-0002 (HMO-POS) | UHC OF California | T1 | No | $0 | CA |
| UHC Sharp Medicare Advantage CA-001P (HMO-POS) | UHC OF California | T1 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-003P (HMO-POS) | UHC OF California | T1 | No | $0 | CA |
Show the next 30 plans
Showing top 50 of 100 plans.
Frequently Asked Questions
Is topiramate 15 MG Oral Capsule covered by Medicare Part D?
Yes, topiramate 15 MG Oral Capsule is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).
What tier is topiramate 15 MG Oral Capsule on Medicare Part D plans?
topiramate 15 MG Oral Capsule averages Tier 2.2 across Part D plans, ranging from Tier 1 to Tier 4.
Does topiramate 15 MG Oral Capsule require prior authorization?
7.9% of Part D formularies require prior authorization for topiramate 15 MG Oral Capsule. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on topiramate 15 MG Oral Capsule?
In 2023, total Medicare Part D spending on topiramate 15 MG Oral Capsule was $56,440,596, covering 644,196 beneficiaries. The average spend per beneficiary was $87.61.
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
- omadacycline 150 MG Oral Tablet [Nuzyra] 7.9% PA
- ampicillin 2000 MG / sulbactam 1000 MG Injection 7.9% PA
- zonisamide 25 MG Oral Capsule 7.9% PA
- zonisamide 100 MG Oral Capsule 7.9% PA
- 12 HR disopyramide 100 MG Extended Release Oral Capsule [Norpace] 8% PA
- phenytoin sodium 100 MG Extended Release Oral Capsule [Dilantin] 8% PA