How Much Does Pantoprazole Cost With Medicare?
Pantoprazole (Pantoprazole Sodium) costs an average of $10 per Medicare Part D claim, with total Medicare spending of $145.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
Key Facts: Pantoprazole Cost
- Medicare Part D avg
- $10/claim
- Likely Part D tier
- Tier 1 (generic)
- Annual cost/patient
- $68
- Generic available
- Yes — Pantoprazole Sodium
- Manufacturer
- Pfizer
- Treats
- GI/Acid Reflux
- YoY price change
- -22.4%
Source: CMS Medicare Part D Spending Dashboard. Tier placement inferred from typical formulary norms — confirm with your specific Part D plan.
Pantoprazole Medicare Coverage & Out-of-Pocket Cost
Pantoprazole is covered under Medicare Part D, with the program paying an average of $10 per prescription fill. Pantoprazole typically falls on Tier 1 (generic) of standard Part D formularies. Typical copay: $0-$10 per fill on most Medicare Part D plans.
Your actual out-of-pocket cost depends on three factors: (1) formulary tier — your plan's specific placement; (2) deductible status — most plans require you to meet up to a $590 deductible (2025) before copays kick in; (3) coverage phase — initial coverage, then the donut hole was eliminated in 2025, replaced by a hard $2,000 annual out-of-pocket cap under the Inflation Reduction Act. Once you hit $2,000 in true out-of-pocket spending, the rest of your Part D drugs are free for the year.
Because generic Pantoprazole Sodium is available, the single biggest savings move is asking your pharmacist about generic substitution. Generics typically sit on Tier 1 with copays under $10, vs Tier 2-3 placement for brand-name Pantoprazole. Most states allow automatic substitution unless your prescriber writes "dispense as written."
For cash-pay or commercial insurance scenarios, compare prices using GoodRx, SingleCare, or Cost Plus Drugs before filling — discount-program prices sometimes beat Part D copays for lower-cost generics.
Pantoprazole is manufactured by Pfizer and prescribed primarily for GI/Acid Reflux. In the most recent Medicare Part D data, 14,580,000 claims were filed for 2,140,000 unique beneficiaries, at an average cost of $10 per claim. Average annual cost per beneficiary is $68.
Year over year, Medicare spending on Pantoprazole has decreased by -22.4%. Because a generic version of Pantoprazole Sodium is available, patients can often substitute to reduce out-of-pocket costs. Its patent expires 2023-01-31.
Key Data
| Metric | Value |
|---|---|
| Avg Cost Per Claim | $10 |
| Total Medicare Spending | $145.0M |
| Total Claims | 14,580,000 |
| Beneficiaries | 2,140,000 |
| Generic Available | Yes |
| Year-Over-Year Change | -22.4% |
Other Drugs for GI/Acid Reflux
Frequently Asked Questions
Medicare Part D pays an average of $10 per claim for Pantoprazole. Pantoprazole is typically placed on Tier 1 (generic) of standard Part D formularies. Typical copay: $0-$10 per fill on most Medicare Part D plans. As of 2025, total annual out-of-pocket on Part D is capped at $2,000 under the Inflation Reduction Act.
Yes. Pantoprazole appears in Medicare Part D claims data, with 2,140,000 beneficiaries filling 14,580,000 prescriptions in the latest year. Specific coverage depends on your plan's formulary — call the number on your insurance card or check the plan's Summary of Benefits to confirm prior authorization, step therapy, or quantity limit requirements.
Pantoprazole (Pantoprazole Sodium) costs an average of $10 per Medicare Part D claim, with total Medicare spending of $145.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
Yes. A generic version of Pantoprazole Sodium is available, which typically costs 80-95% less than brand-name Pantoprazole. Ask your pharmacist about generic substitution — most state laws allow automatic substitution unless your prescriber writes "dispense as written."
Medicare beneficiaries cannot use manufacturer copay cards (anti-kickback statute), but several options exist: (1) Apply to charity copay foundations like the PAN Foundation, NeedyMeds, HealthWell Foundation, or Patient Advocate Foundation — many cover gi/acid reflux drugs; (2) Ask your prescriber about therapeutic alternatives in the same drug class that may be on a lower tier; (3) For some drugs, paying cash via GoodRx or Cost Plus Drugs can beat your Medicare copay — always compare before filling; (4) If your income is below 150% of the federal poverty level, you may qualify for the Medicare Extra Help (Low-Income Subsidy) program, which reduces Part D costs to near-zero.
Pantoprazole is manufactured by Pfizer. The FDA application number is BLA125057.
Pantoprazole (Pantoprazole Sodium) is primarily prescribed for GI/Acid Reflux.
Medicare Part D spending on Pantoprazole has decreased -22.4% year over year. Total program spending reached $145.0M in the latest reporting year.
Pantoprazole (Pantoprazole Sodium) costs an average of $10 per Medicare Part D claim, with total Medicare spending of $145.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
The data source behind this answer is CMS Medicare Part D Drug Spending data. Every figure on the page traces back to that source; the methodology page describes the inputs and the refresh cadence in full detail.
For readers turning this answer into action: cross-reference against the underlying CMS Medicare Part D Drug Spending data record before acting on time-sensitive decisions. The site renders the data as it was published; subsequent revisions can shift the picture, and the live federal data is always the authoritative current reference.
Source: CMS Medicare Part D Spending, 2026.