Medicare Part D coverage · {14 · RxCUI 2054275
{14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet]
Per the CMS 2026 Part D formulary file, {14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet] is covered by 151 Medicare Part D plans (3% of enrollable products), averaging Tier 4.4, with prior authorization required on 100% of covering formularies.
- 3%
- Plan coverage
- 151
- Plans covering
- T4.4
- Avg tier
- 100%
- Prior auth required
What the CMS Formulary Data Shows for {14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet]
Per the CMS 2026 Part D formulary file, {14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet] (RxNorm concept RXCUI 2054275, generic name {14) appears on 27 distinct formulary files spanning 151 Medicare Part D plan offerings - 3% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.4.
Real-world access to {14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 55.6% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 114 Part D beneficiaries filled {14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet] in 2023, with total plan-and-beneficiary spending of $34,842,425 and an average per-beneficiary annual cost of $305,635.31. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry {14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet] today.
Coverage Details
- Formularies covering
- 27
- Plans covering
- 151
- Coverage rate
- 3%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 55.6% of formularies
2023 Medicare Spending
- Beneficiaries
- 114
- Total spending
- $34,842,425
- Avg per beneficiary
- $305,635.31
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering {14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | Yes | $17.00 | AZ |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T2 | Yes | $0 | CA |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T4 | Yes | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T4 | Yes | $0 | NY |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS Choice | T4 | Yes | $51.60 | NY |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T5 | Yes | $0 | FL |
| HealthSun MediMax (HMO) | Healthsun Health Plans, Inc. | T5 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T5 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T5 | Yes | $0 | FL |
| HealthSun MediSun Plus (HMO D-SNP) | Healthsun Health Plans, Inc. | T5 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T5 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T5 | Yes | $0 | FL |
| HealthSun MediSun Extra (HMO D-SNP) | Healthsun Health Plans, Inc. | T5 | Yes | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T5 | Yes | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | Healthsun Health Plans, Inc. | T5 | Yes | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | Healthsun Health Plans, Inc. | T5 | Yes | $0 | FL |
Show the next 30 plans
| HealthSun MediSun Full Dual Plus (HMO D-SNP) | Healthsun Health Plans, Inc. | T5 | Yes | $0 | FL |
| HealthSun MediSun Full Dual Extra (HMO D-SNP) | Healthsun Health Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Extra (HMO) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply More Platinum (HMO) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Complete Platinum (HMO D-SNP) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Extra Platinum (HMO) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply More Platinum (HMO) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Complete Platinum (HMO D-SNP) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | Simply Healthcare Plans, Inc. | T5 | Yes | $0 | FL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is {14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet] covered by Medicare Part D?
Yes, {14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet] is covered by 151 Medicare Part D plans (3% of all Part D formularies).
What tier is {14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet] on Medicare Part D plans?
{14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet] averages Tier 4.4 across Part D plans, ranging from Tier 1 to Tier 5.
Does {14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet] require prior authorization?
100% of Part D formularies require prior authorization for {14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet]. Step therapy: 0%. Quantity limits: 55.6%.
How much does Medicare spend on {14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet]?
In 2023, total Medicare Part D spending on {14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet] was $34,842,425, covering 114 beneficiaries. The average spend per beneficiary was $305,635.31.
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
- sodium phenylbutyrate 500 MG Oral Tablet T4.4
- omadacycline 150 MG Oral Tablet [Nuzyra] T4.4
- 20 ML immunoglobulin G, human 100 MG/ML Injection [Octagam] T4.4
- nilotinib d-tartrate 50 MG Oral Capsule T4.4
- 20 ML immunoglobulin G, human 50 MG/ML Injection [Octagam] T4.4
- elafibranor 80 MG Oral Tablet [Iqirvo] T4.4
Similar prior-authorization rate
- azathioprine 50 MG Oral Tablet 100% PA
- 0.5 ML hepatitis B surface antigen vaccine 0.04 MG/ML Prefilled Syringe [Heplisav-B] 100% PA
- 0.5 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] 100% PA
- 1 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] 100% PA
- sotagliflozin 200 MG Oral Tablet [Inpefa] 100% PA
- mycophenolate mofetil 250 MG Oral Capsule 100% PA