{14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet]
migalastat
RxCUI: 2054275
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 migalastat) 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 |
| 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 |
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.