zolmitriptan 2.5 MG/ACTUAT Nasal Spray
zolmitriptan
RxCUI: 1483677
What the CMS Formulary Data Shows for zolmitriptan 2.5 MG/ACTUAT Nasal Spray
Per the CMS 2026 Part D formulary file, zolmitriptan 2.5 MG/ACTUAT Nasal Spray (RxNorm concept RXCUI 1483677, generic name zolmitriptan) appears on 10 distinct formulary files spanning 44 Medicare Part D plan offerings - 0.9% 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 2.9.
Real-world access to zolmitriptan 2.5 MG/ACTUAT Nasal Spray depends on utilization management as much as tier placement: 10% of covering formularies require prior authorization. 20% require step therapy. 100% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 11,158 Part D beneficiaries filled zolmitriptan 2.5 MG/ACTUAT Nasal Spray in 2023, with total plan-and-beneficiary spending of $8,224,308 and an average per-beneficiary annual cost of $737.08. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry zolmitriptan 2.5 MG/ACTUAT Nasal Spray today.
Coverage Details
- Formularies covering
- 10
- Plans covering
- 44
- Coverage rate
- 0.9%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 10% of formularies
- Step therapy required
- 20% of formularies
- Quantity limits
- 100% of formularies
2023 Medicare Spending
- Beneficiaries
- 11,158
- Total spending
- $8,224,308
- Avg per beneficiary
- $737.08
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering zolmitriptan 2.5 MG/ACTUAT Nasal Spray
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP) | HM HEALTH INSURANCE COMPANY | T4 | No | No | $164.80 | - |
| Blue Rx PDP Plus (PDP) | HM HEALTH INSURANCE COMPANY | T4 | No | No | $193.20 | - |
Medicare Advantage Plans (MA-PD) Covering zolmitriptan 2.5 MG/ACTUAT Nasal Spray
42 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Mass General Brigham SCO (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | No | $0 | MA |
| Healthy Mississippi Premier Advantage (HMO-POS) | Healthy Mississippi, Inc. | T2 | No | $0 | MS |
| 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 |
| Mass General Brigham Advantage (PPO) | Mass General Brigham Health Plan, Inc. | T3 | No | $0 | MA |
| Health New England Medicare Premium (HMO) | HEALTH NEW ENGLAND, INC. | T3 | No | $15.80 | MA |
| Health New England Medicare Plus (HMO) | HEALTH NEW ENGLAND, INC. | T3 | No | $58.40 | MA |
| Mass General Brigham Advantage Secure (HMO-POS) | Mass General Brigham Health Plan, Inc. | T3 | No | $62.00 | MA |
| Mass General Brigham Advantage Premier (PPO) | Mass General Brigham Health Plan, Inc. | T3 | No | $79.70 | MA |
| Mass General Brigham Advantage Signature (PPO) | Mass General Brigham Health Plan, Inc. | T3 | No | $147.20 | MA |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Flex (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Active (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Select Health Medicare Wellness (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Network Health Select (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $0 | WI |
| Network Health Go (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $0 | WI |
| Network Health Anywhere (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $0 | WI |
| Network Health Choice (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $0 | WI |
| Network Health Zero (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $0 | WI |
| Samaritan Dual Advantage (HMO D-SNP) | SAMARITAN HEALTH PLANS, INC. | T4 | No | $10.50 | OR |
| Network Health Cares (PPO D-SNP) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $21.10 | WI |
| Network Health PlusRx (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $38.60 | WI |
| Security Blue HMO-POS Standard (HMO-POS) | HIGHMARK CHOICE COMPANY | T4 | No | $51.80 | PA |
| Network Health PremierRx (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $92.80 | WI |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $95.70 | PA |
| Security Blue HMO-POS Deluxe (HMO-POS) | HIGHMARK CHOICE COMPANY | T4 | No | $95.90 | PA |
| Freedom Blue PPO Standard (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $98.20 | PA |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $115.70 | PA |
| Freedom Blue PPO Deluxe (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $122.40 | PA |
| Freedom Blue PPO Classic (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $140.90 | PA |
| Freedom Blue PPO Classic (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $145.40 | PA |
Frequently Asked Questions
Is zolmitriptan 2.5 MG/ACTUAT Nasal Spray covered by Medicare Part D?
Yes, zolmitriptan 2.5 MG/ACTUAT Nasal Spray is covered by 44 Medicare Part D plans (0.9% of all Part D formularies).
What tier is zolmitriptan 2.5 MG/ACTUAT Nasal Spray on Medicare Part D plans?
zolmitriptan 2.5 MG/ACTUAT Nasal Spray averages Tier 2.9 across Part D plans, ranging from Tier 1 to Tier 4.
Does zolmitriptan 2.5 MG/ACTUAT Nasal Spray require prior authorization?
10% of Part D formularies require prior authorization for zolmitriptan 2.5 MG/ACTUAT Nasal Spray. Step therapy: 20%. Quantity limits: 100%.
How much does Medicare spend on zolmitriptan 2.5 MG/ACTUAT Nasal Spray?
In 2023, total Medicare Part D spending on zolmitriptan 2.5 MG/ACTUAT Nasal Spray was $8,224,308, covering 11,158 beneficiaries. The average spend per beneficiary was $737.08.
Read our methodology - how this data is sourced, computed, and verified.