Medicare Part D coverage · 0.4 · RxCUI 1244064
0.4 ML methylnaltrexone bromide 20 MG/ML Prefilled Syringe [Relistor]
Per the CMS 2026 Part D formulary file, 0.4 ML methylnaltrexone bromide 20 MG/ML Prefilled Syringe [Relistor] is covered by 1,163 Medicare Part D plans (23% of enrollable products), averaging Tier 4.1, with prior authorization required on 67.4% of covering formularies.
- 23%
- Plan coverage
- 1,163
- Plans covering
- T4.1
- Avg tier
- 67.4%
- Prior auth required
What the CMS Formulary Data Shows for 0.4 ML methylnaltrexone bromide 20 MG/ML Prefilled Syringe [Relistor]
Per the CMS 2026 Part D formulary file, 0.4 ML methylnaltrexone bromide 20 MG/ML Prefilled Syringe [Relistor] (RxNorm concept RXCUI 1244064, generic name 0.4) appears on 141 distinct formulary files spanning 1,163 Medicare Part D plan offerings - 23% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 4.1.
Real-world access to 0.4 ML methylnaltrexone bromide 20 MG/ML Prefilled Syringe [Relistor] depends on utilization management as much as tier placement: 67.4% of covering formularies require prior authorization. 28.4% require step therapy. 87.2% apply quantity limits.
Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 0.4 ML methylnaltrexone bromide 20 MG/ML Prefilled Syringe [Relistor] today.
Coverage Details
- Formularies covering
- 141
- Plans covering
- 1,163
- Coverage rate
- 23%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 67.4% of formularies
- Step therapy required
- 28.4% of formularies
- Quantity limits
- 87.2% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 0.4 ML methylnaltrexone bromide 20 MG/ML Prefilled Syringe [Relistor]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $0 | NJ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | Yes | $0 | NY |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | No | $0 | GA |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | No | $0 | MI |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
Show the next 30 plans
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $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 |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| 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 |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | Yes | $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 |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | Yes | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $0 | DE |
| Florida Complete Care (HMO I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | No | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | No | $4.80 | TX |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | No | $8.80 | MI |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $13.10 | PA |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Illinois, Inc. | T1 | No | $15.20 | IL |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Illinois | T1 | No | $15.20 | IL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 0.4 ML methylnaltrexone bromide 20 MG/ML Prefilled Syringe [Relistor] covered by Medicare Part D?
Yes, 0.4 ML methylnaltrexone bromide 20 MG/ML Prefilled Syringe [Relistor] is covered by 1,163 Medicare Part D plans (23% of all Part D formularies).
What tier is 0.4 ML methylnaltrexone bromide 20 MG/ML Prefilled Syringe [Relistor] on Medicare Part D plans?
0.4 ML methylnaltrexone bromide 20 MG/ML Prefilled Syringe [Relistor] averages Tier 4.1 across Part D plans, ranging from Tier 1 to Tier 6.
Does 0.4 ML methylnaltrexone bromide 20 MG/ML Prefilled Syringe [Relistor] require prior authorization?
67.4% of Part D formularies require prior authorization for 0.4 ML methylnaltrexone bromide 20 MG/ML Prefilled Syringe [Relistor]. Step therapy: 28.4%. Quantity limits: 87.2%.
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
- {14 (cenobamate 100 MG Oral Tablet [Xcopri]) / 14 (cenobamate 50 MG Oral Tablet [Xcopri]) } Pack [Xcopri Titration Pack - 50 MG (14), 100 MG (14) 28 Count] T4.1
- {28 (cenobamate 150 MG Oral Tablet [Xcopri]) / 28 (cenobamate 200 MG Oral Tablet) } Pack [Xcopri 350 MG Maintenance Pack] T4.1
- atazanavir 50 MG Oral Powder [Reyataz] T4.1
- cenobamate 50 MG Oral Tablet [Xcopri] T4.1
- clobazam 10 MG Oral Film [Sympazan] T4.1
- pimavanserin 10 MG Oral Tablet [Nuplazid] T4.1
Similar prior-authorization rate
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- testosterone cypionate 100 MG/ML Injectable Solution 67.7% PA
- vericiguat 10 MG Oral Tablet [Verquvo] 67.7% PA
- lidocaine 0.05 MG/MG Topical Ointment 67.8% PA
- alitretinoin 0.001 MG/MG Topical Gel [Panretin] 66.8% PA
- metyrosine 250 MG Oral Capsule 66.8% PA