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Ampicillin and Sulbactam 2 g/3g / 1 g/3g Medicare Part D Coverage

Dosage form
INJECTION, POWDER, FOR SOLUTION
Route
INTRAVENOUS
Drug class
Antibiotics — Penicillins
100%
of Medicare Part D plans
cover Ampicillin and Sulbactam
5,529 of 5,530 plans
3.6
Avg. formulary tier
$12.00
Median 30-day copay
$0.00–$24.00
Copay range

Formulary Tier Distribution

How Medicare Part D plans classify Ampicillin and Sulbactam. Lower tiers = lower copays.

Tier 1 - Preferred Generic 3%
173 plans • avg $0.00/mo
Tier 2 - Generic 14%
800 plans • avg $2.02/mo
Tier 3 - Preferred Brand 4%
244 plans • avg $1.45/mo
Tier 4 - Non-Preferred Drug 78%
4,293 plans • avg $4.51/mo
Tier 6 - Select Care 0%
19 plans • avg $0.00/mo

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Ampicillin and Sulbactam Medicare Coverage by State

Coverage rates and average costs vary significantly by state. Click a state to see the specific plans available there.

Alabama 100% Arizona 100% Arkansas 100% California 100% avg $0.11 Colorado 100% Connecticut 100% Delaware 100% District of Columbia 100% Florida 100% avg $0.23 Georgia 100% avg $0.07 Hawaii 100% Idaho 100% Illinois 100% Indiana 100% Iowa 100% Kansas 100% Kentucky 100% Louisiana 100% Maine 100% avg $0.82 Maryland 100% avg $1.07 Massachusetts 100% avg $7.03 Michigan 100% avg $9.05 Minnesota 100% Mississippi 100% Missouri 100% Montana 100% Nebraska 100% Nevada 100% New Hampshire 100% New Jersey 100% New Mexico 100% New York 100% North Carolina 100% North Dakota 100% Ohio 100% Oklahoma 100% Oregon 100% avg $0.22 Pennsylvania 100% Puerto Rico 100% Rhode Island 100% South Carolina 100% South Dakota 100% Tennessee 100% avg $3.12 Texas 100% Utah 100% avg $4.09 Vermont 100% Virginia 100% Washington 100% avg $1.10 West Virginia 100% Wisconsin 100% Wyoming 100%

Alternative Medications in the Same Drug Class

Other drugs in the Antibiotics — Penicillins that Medicare Part D plans also cover.

Amoxicillin and Clavulanate Potassium Avg Tier 2.2 $15.00/mo 5,529 plans Amoxicillin Avg Tier 1.4 $18.00/mo 5,529 plans Amoxicillin Avg Tier 1.2 $18.00/mo 5,529 plans Amoxicillin Avg Tier 1.2 $18.00/mo 5,529 plans Amoxicillin Avg Tier 1.2 $18.00/mo 5,529 plans Ampicillin Avg Tier 1.9 $15.00/mo 5,529 plans Amoxicillin Avg Tier 1.3 $18.00/mo 5,529 plans Amoxicillin and Clavulanate Potassium Avg Tier 2.3 $15.00/mo 5,529 plans

Frequently Asked Questions about Ampicillin and Sulbactam

100% of Medicare Part D plans cover Ampicillin and Sulbactam. It is most commonly placed on Tier 4. Coverage varies by plan and geographic area.

The median 30-day copay for Ampicillin and Sulbactam on Medicare Part D is $12.00 at a preferred pharmacy. Costs range from $0.00 to $24.00 depending on the plan.

Ampicillin and Sulbactam is placed on Tier 4 by most Medicare Part D plans. Lower tier numbers generally mean lower copays.

0% of plans require prior authorization for Ampicillin and Sulbactam. Prior authorization means your doctor must confirm the drug is medically necessary before the plan will cover it.

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Coverage statistics based on CMS formulary data for plan year 2026. Data updated regularly. Methodology →