Medicare Part D coverage · topiramate · RxCUI 199888
topiramate 25 MG Oral Tablet
Per the CMS 2026 Part D formulary file, topiramate 25 MG Oral Tablet is covered by 5,052 Medicare Part D plans (100% of enrollable products), averaging Tier 1.5, with prior authorization required on 7.9% of covering formularies.
- 100%
- Plan coverage
- 5,052
- Plans covering
- T1.5
- Avg tier
- 7.9%
- Prior auth required
What the CMS Formulary Data Shows for topiramate 25 MG Oral Tablet
Per the CMS 2026 Part D formulary file, topiramate 25 MG Oral Tablet (RxNorm concept RXCUI 199888, 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 2, with a cross-plan average of Tier 1.5.
Real-world access to topiramate 25 MG Oral Tablet depends on utilization management as much as tier placement: 7.9% of covering formularies require prior authorization. 0% require step therapy. 3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 644,196 Part D beneficiaries filled topiramate 25 MG Oral Tablet 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 25 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 328
- Plans covering
- 5,052
- Coverage rate
- 100%
- Tier range
- Tier 1 – Tier 2
- Average tier
- Tier 1, Preferred Generic
Restrictions
- Prior authorization required
- 7.9% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 3% 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 25 MG Oral Tablet
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 25 MG Oral Tablet covered by Medicare Part D?
Yes, topiramate 25 MG Oral Tablet is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).
What tier is topiramate 25 MG Oral Tablet on Medicare Part D plans?
topiramate 25 MG Oral Tablet averages Tier 1.5 across Part D plans, ranging from Tier 1 to Tier 2.
Does topiramate 25 MG Oral Tablet require prior authorization?
7.9% of Part D formularies require prior authorization for topiramate 25 MG Oral Tablet. Step therapy: 0%. Quantity limits: 3%.
How much does Medicare spend on topiramate 25 MG Oral Tablet?
In 2023, total Medicare Part D spending on topiramate 25 MG Oral Tablet 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
- bisoprolol fumarate 2.5 MG / hydrochlorothiazide 6.25 MG Oral Tablet T1.5
- estradiol 0.1 MG/ML Vaginal Cream [Estrace] T1.5
- glycopyrrolate 1.5 MG Oral Tablet T1.5
- terbinafine 250 MG Oral Tablet T1.5
- bisoprolol fumarate 10 MG / hydrochlorothiazide 6.25 MG Oral Tablet T1.5
- hydrocortisone 10 MG/ML Topical Cream T1.5
Similar prior-authorization rate
- omadacycline 150 MG Oral Tablet [Nuzyra] 7.9% PA
- ampicillin 2000 MG / sulbactam 1000 MG Injection 7.9% PA
- zonisamide 100 MG Oral Capsule 7.9% PA
- zonisamide 25 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