Medicare Part D coverage · zolpidem tartrate · RxCUI 1232202
zolpidem tartrate 3.5 MG Sublingual Tablet
Per the CMS 2026 Part D formulary file, zolpidem tartrate 3.5 MG Sublingual Tablet is covered by 42 Medicare Part D plans (0.8% of enrollable products), averaging Tier 3.2, with prior authorization required on 20% of covering formularies.
- 0.8%
- Plan coverage
- 42
- Plans covering
- T3.2
- Avg tier
- 20%
- Prior auth required
What the CMS Formulary Data Shows for zolpidem tartrate 3.5 MG Sublingual Tablet
Per the CMS 2026 Part D formulary file, zolpidem tartrate 3.5 MG Sublingual Tablet (RxNorm concept RXCUI 1232202, generic name zolpidem tartrate) appears on 5 distinct formulary files spanning 42 Medicare Part D plan offerings - 0.8% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 3 to Tier 4, with a cross-plan average of Tier 3.2.
Real-world access to zolpidem tartrate 3.5 MG Sublingual Tablet depends on utilization management as much as tier placement: 20% of covering formularies require prior authorization. 0% require step therapy. 100% 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 3.5 MG Sublingual 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 3.5 MG Sublingual Tablet today.
Coverage Details
- Formularies covering
- 5
- Plans covering
- 42
- Coverage rate
- 0.8%
- Tier range
- Tier 3 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 20% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 100% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,435,449
- Total spending
- $60,777,775
- Avg per beneficiary
- $42.34
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering zolpidem tartrate 3.5 MG Sublingual Tablet
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP) | HM Health Insurance Company | T3 | Yes | No | $164.80 | - |
| Blue Rx PDP Plus (PDP) | HM Health Insurance Company | T3 | Yes | No | $193.20 | - |
Medicare Advantage Plans (MA-PD) Covering zolpidem tartrate 3.5 MG Sublingual Tablet
40 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Medicare BlueEssential (PPO) | Excellus Health Plan, Inc. | T3 | No | $0 | NY |
| Medicare BlueActive (PPO) | Excellus Health Plan, Inc. | T3 | No | $0 | NY |
| Medicare BlueVital (PPO) | Excellus Health Plan, Inc. | T3 | No | $0 | NY |
| Univera SeniorChoice Basic (HMO) | Excellus Health Plan, Inc. | T3 | No | $0 | NY |
| Univera SeniorChoice Extra (HMO) | Excellus Health Plan, Inc. | T3 | No | $0 | NY |
| Medicare Blue Choice Core (HMO) | Excellus Health Plan, Inc. | T3 | No | $0 | NY |
| Univera Medicare Dual (HMO D-SNP) | Excellus Health Plan Community Care LLC | T3 | No | $0 | NY |
| Medicare Blue Dual (HMO D-SNP) | Excellus Health Plan Community Care LLC | T3 | No | $0 | NY |
| CDPHP $0 Medicare Rx (HMO) | Capital District Physicians' Health Plan, Inc. | T3 | No | $0 | NY |
| Univera SeniorChoice Core (PPO) | Excellus Health Plan, Inc. | T3 | No | $33.00 | NY |
| Univera SeniorChoice Advanced (HMO-POS) | Excellus Health Plan, Inc. | T3 | No | $36.90 | NY |
| Medicare BlueClassic (PPO) | Excellus Health Plan, Inc. | T3 | No | $51.00 | NY |
| Security Blue HMO-POS Standard (HMO-POS) | Highmark Choice Company | T3 | Yes | $51.80 | PA |
| Univera SeniorChoice Secure (HMO-POS) | Excellus Health Plan, Inc. | T3 | No | $54.90 | NY |
| Medicare BlueBalanced (PPO) | Excellus Health Plan, Inc. | T3 | No | $55.00 | NY |
| Medicare Blue Choice Prime (HMO) | Excellus Health Plan, Inc. | T3 | No | $55.00 | NY |
| Univera SeniorChoice Value Plus (HMO-POS) | Excellus Health Plan, Inc. | T3 | No | $58.60 | NY |
| Medicare BlueEnhanced (PPO) | Excellus Health Plan, Inc. | T3 | No | $70.30 | NY |
| Medicare BluePlus (PPO) | Excellus Health Plan, Inc. | T3 | No | $86.40 | NY |
| Freedom Blue PPO Select (PPO) | Highmark Senior Health Company | T3 | Yes | $95.70 | PA |
Show the next 20 plans
| Security Blue HMO-POS Deluxe (HMO-POS) | Highmark Choice Company | T3 | Yes | $95.90 | PA |
| Freedom Blue PPO Standard (PPO) | Highmark Senior Health Company | T3 | Yes | $98.20 | PA |
| CDPHP Clear Rx (HMO) | Capital District Physicians' Health Plan, Inc. | T3 | No | $100.00 | NY |
| Freedom Blue PPO Select (PPO) | Highmark Senior Health Company | T3 | Yes | $115.70 | PA |
| Freedom Blue PPO Deluxe (PPO) | Highmark Senior Health Company | T3 | Yes | $122.40 | PA |
| CDPHP Choice Rx (HMO) | Capital District Physicians' Health Plan, Inc. | T3 | No | $135.00 | NY |
| Freedom Blue PPO Classic (PPO) | Highmark Senior Health Company | T3 | Yes | $140.90 | PA |
| Freedom Blue PPO Classic (PPO) | Highmark Senior Health Company | T3 | Yes | $145.40 | PA |
| Medicare Blue Choice Optimum (HMO-POS) | Excellus Health Plan, Inc. | T3 | No | $146.00 | NY |
| PacificSource Medicare Essentials Rx 27 (HMO) | Pacificsource Community Health Plans | T4 | No | $0 | OR |
| PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) | Pacificsource Community Health Plans | T4 | No | $0 | MT |
| PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) | Pacificsource Community Health Plans | T4 | No | $0 | OR |
| PacificSource Medicare MyCare Rx 40 (HMO) | Pacificsource Community Health Plans | T4 | No | $0 | OR |
| PacificSource Dual Care (HMO D-SNP) | Pacificsource Community Health Plans | T4 | No | $0 | OR |
| PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) | Pacificsource Community Health Plans | T4 | No | $19.00 | ID |
| PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) | Pacificsource Community Health Plans | T4 | No | $29.10 | OR |
| PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) | Pacificsource Community Health Plans | T4 | No | $52.00 | ID |
| PacificSource Medicare Essentials Rx 41 (HMO) | Pacificsource Community Health Plans | T4 | No | $69.30 | OR |
| PacificSource Medicare Explorer Rx 4 (PPO) | Pacificsource Community Health Plans | T4 | No | $88.70 | OR |
| PacificSource Medicare Essentials Rx 6 (HMO) | Pacificsource Community Health Plans | T4 | No | $105.90 | OR |
Frequently Asked Questions
Is zolpidem tartrate 3.5 MG Sublingual Tablet covered by Medicare Part D?
Yes, zolpidem tartrate 3.5 MG Sublingual Tablet is covered by 42 Medicare Part D plans (0.8% of all Part D formularies).
What tier is zolpidem tartrate 3.5 MG Sublingual Tablet on Medicare Part D plans?
zolpidem tartrate 3.5 MG Sublingual Tablet averages Tier 3.2 across Part D plans, ranging from Tier 3 to Tier 4.
Does zolpidem tartrate 3.5 MG Sublingual Tablet require prior authorization?
20% of Part D formularies require prior authorization for zolpidem tartrate 3.5 MG Sublingual Tablet. Step therapy: 0%. Quantity limits: 100%.
How much does Medicare spend on zolpidem tartrate 3.5 MG Sublingual Tablet?
In 2023, total Medicare Part D spending on zolpidem tartrate 3.5 MG Sublingual 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 diazepam 5 MG/ML Rectal Gel T3.2
- phenytoin sodium 30 MG Extended Release Oral Capsule [Dilantin] T3.2
- alanine 8.8 MG/ML / arginine 4.89 MG/ML / glucose 50 MG/ML / glycine 4.38 MG/ML / histidine 2.04 MG/ML / isoleucine 2.55 MG/ML / leucine 3.11 MG/ML / lysine 2.47 MG/ML / methionine 1.7 MG/ML / phenylalanine 2.38 MG/ML / proline 2.89 MG/ML / serine 2.13 MG/ML / threonine 1.79 MG/ML / tryptophan 0.77 MG/ML / tyrosine 0.17 MG/ML / valine 2.47 MG/ML Injectable Solution [Clinimix 4.25/5] T3.2
- alanine 10.4 MG/ML / arginine 5.75 MG/ML / glucose 200 MG/ML / glycine 5.15 MG/ML / histidine 2.4 MG/ML / isoleucine 3 MG/ML / leucine 3.65 MG/ML / lysine 2.9 MG/ML / methionine 2 MG/ML / phenylalanine 2.8 MG/ML / proline 3.4 MG/ML / serine 2.5 MG/ML / threonine 2.1 MG/ML / tryptophan 0.9 MG/ML / tyrosine 0.2 MG/ML / valine 2.9 MG/ML Injectable Solution [Clinimix 5/20] T3.2
- citric acid 68.6 MG/ML / magnesium oxide 20 MG/ML / picosulfate sodium 0.0571 MG/ML Oral Solution [Clenpiq] T3.2
- fluorometholone acetate 1 MG/ML Ophthalmic Suspension [Flarex] T3.2
Similar prior-authorization rate
- cyclosporine 0.9 MG/ML Ophthalmic Solution [Cequa] 20% PA
- amphetamine aspartate 7.5 MG / amphetamine sulfate 7.5 MG / dextroamphetamine saccharate 7.5 MG / dextroamphetamine sulfate 7.5 MG Oral Tablet 19.9% PA
- amphetamine aspartate 3.125 MG / amphetamine sulfate 3.125 MG / dextroamphetamine saccharate 3.125 MG / dextroamphetamine sulfate 3.125 MG Oral Tablet 20.1% PA
- sevelamer carbonate 2400 MG Powder for Oral Suspension 19.8% PA
- patiromer 25200 MG Powder for Oral Suspension [Veltassa] 19.8% PA
- linezolid 600 MG Oral Tablet 19.8% PA