Medicare Part D coverage · zolpidem tartrate · RxCUI 854880
zolpidem tartrate 12.5 MG Extended Release Oral Tablet
Per the CMS 2026 Part D formulary file, zolpidem tartrate 12.5 MG Extended Release Oral Tablet is covered by 1,398 Medicare Part D plans (27.7% of enrollable products), averaging Tier 2.2, with prior authorization required on 30.4% of covering formularies.
- 27.7%
- Plan coverage
- 1,398
- Plans covering
- T2.2
- Avg tier
- 30.4%
- Prior auth required
What the CMS Formulary Data Shows for zolpidem tartrate 12.5 MG Extended Release Oral Tablet
Per the CMS 2026 Part D formulary file, zolpidem tartrate 12.5 MG Extended Release Oral Tablet (RxNorm concept RXCUI 854880, generic name zolpidem tartrate) appears on 102 distinct formulary files spanning 1,398 Medicare Part D plan offerings - 27.7% 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 2.2.
Real-world access to zolpidem tartrate 12.5 MG Extended Release Oral Tablet depends on utilization management as much as tier placement: 30.4% of covering formularies require prior authorization. 0% require step therapy. 95.1% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 1,435,449 Part D beneficiaries filled zolpidem tartrate 12.5 MG Extended Release Oral Tablet in 2023, with total plan-and-beneficiary spending of $60,777,775 and an average per-beneficiary annual cost of $42.34. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry zolpidem tartrate 12.5 MG Extended Release Oral Tablet today.
Coverage Details
- Formularies covering
- 102
- Plans covering
- 1,398
- Coverage rate
- 27.7%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 30.4% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 95.1% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,435,449
- Total spending
- $60,777,775
- Avg per beneficiary
- $42.34
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering zolpidem tartrate 12.5 MG Extended Release Oral Tablet
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | No | $0 | AL |
| DrMax (HMO) | Doctors Healthcare Plans, Inc. | T1 | No | $0 | FL |
| DrExtraCare (HMO C-SNP) | Doctors Healthcare Plans, Inc. | T1 | No | $0 | FL |
| DrSelect (HMO) | Doctors Healthcare Plans, Inc. | T1 | No | $0 | FL |
| DrSelect-CFL (HMO) | Doctors Healthcare Plans, Inc. | T1 | No | $0 | FL |
| DrPlatinum-CFL (HMO D-SNP) | Doctors Healthcare Plans, Inc. | T1 | No | $0 | FL |
| DrTotalCare-CFL (HMO C-SNP) | Doctors Healthcare Plans, Inc. | T1 | No | $0 | FL |
| DrElite-SFL (HMO) | Doctors Healthcare Plans, Inc. | T1 | No | $0 | FL |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | Yes | $0 | CA |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T1 | No | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T1 | No | $0 | NY |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $0 | MO |
Show the next 30 plans
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Advance (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Plus (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | Yes | $0 | CA |
| 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 |
| Leon MediExtra (HMO) | Leon Health, Inc. | T1 | No | $0 | FL |
| Leon MediDual (HMO D-SNP) | Leon Health, Inc. | T1 | No | $0 | FL |
| Leon MediMore (HMO) | Leon Health, Inc. | T1 | No | $0 | FL |
| Leon MediMax (HMO D-SNP) | Leon Health, Inc. | T1 | No | $0 | FL |
| DrFlex (HMO D-SNP) | Doctors Healthcare Plans, Inc. | T1 | No | $1.10 | FL |
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | Yes | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | American Health Plan OF FL, Inc. | T1 | No | $4.80 | FL |
| SECUR Advantage (HMO I-SNP) | Secur Inc | T1 | No | $4.80 | FL |
| SECUR Enhanced (HMO I-SNP) | Secur Inc | T1 | No | $4.80 | FL |
| DrPlus (HMO D-SNP) | Doctors Healthcare Plans, Inc. | T1 | No | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | No | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | No | $4.80 | TX |
| Senior Care (HMO I-SNP) | Align Senior Care MI, LLC | T1 | Yes | $8.80 | MI |
| AgeRight Advantage Health Plan (HMO I-SNP) | Marquis Advantage, Inc. | T1 | Yes | $10.50 | OR, WA |
| Senior Care (HMO I-SNP) | Align Senior Care California Inc. | T1 | Yes | $12.00 | CA |
| Liberty Medicare Dual Plan (HMO D-SNP) | Liberty Advantage, LLC | T1 | No | $14.70 | NC |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Illinois | T1 | No | $15.20 | IL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | No | $17.00 | AZ |
| KeyCare Advantage (HMO I-SNP) | Isnp Ventures, LLC | T1 | Yes | $23.20 | MD |
| American Health Advantage of Mississippi (HMO I-SNP) | American Health Plan OF MS, Inc. | T1 | No | $23.80 | MS |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is zolpidem tartrate 12.5 MG Extended Release Oral Tablet covered by Medicare Part D?
Yes, zolpidem tartrate 12.5 MG Extended Release Oral Tablet is covered by 1,398 Medicare Part D plans (27.7% of all Part D formularies).
What tier is zolpidem tartrate 12.5 MG Extended Release Oral Tablet on Medicare Part D plans?
zolpidem tartrate 12.5 MG Extended Release Oral Tablet averages Tier 2.2 across Part D plans, ranging from Tier 1 to Tier 4.
Does zolpidem tartrate 12.5 MG Extended Release Oral Tablet require prior authorization?
30.4% of Part D formularies require prior authorization for zolpidem tartrate 12.5 MG Extended Release Oral Tablet. Step therapy: 0%. Quantity limits: 95.1%.
How much does Medicare spend on zolpidem tartrate 12.5 MG Extended Release Oral Tablet?
In 2023, total Medicare Part D spending on zolpidem tartrate 12.5 MG Extended Release Oral Tablet was $60,777,775, covering 1,435,449 beneficiaries. The average spend per beneficiary was $42.34.
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
- 0.5 ML Haemophilus influenzae type b strain 20752, capsular polysaccharide inactivated tetanus toxoid conjugate vaccine 0.07 MG/ML Injection [Hiberix] T2.2
- promethazine hydrochloride 12.5 MG Oral Tablet T2.2
- misoprostol 0.1 MG Oral Tablet T2.2
- promethazine hydrochloride 25 MG Oral Tablet T2.2
- promethazine hydrochloride 50 MG Oral Tablet T2.2
- amphetamine aspartate 3.125 MG / amphetamine sulfate 3.125 MG / dextroamphetamine saccharate 3.125 MG / dextroamphetamine sulfate 3.125 MG Oral Tablet T2.2
Similar prior-authorization rate
- 5 ML hydromorphone hydrochloride 10 MG/ML Injection 30.5% PA
- calcium acetate 667 MG Oral Capsule 30.2% PA
- 24 HR lacosamide 200 MG Extended Release Oral Capsule [Motpoly] 30.8% PA
- 72 HR scopolamine 0.0139 MG/HR Transdermal System 30.8% PA
- 24 HR lacosamide 100 MG Extended Release Oral Capsule [Motpoly] 30.8% PA
- amitriptyline hydrochloride 10 MG Oral Tablet 30.8% PA