Medicare Part D coverage · 24 · RxCUI 1433235
24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima]
Per the CMS 2026 Part D formulary file, 24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima] is covered by 5,052 Medicare Part D plans (100% of enrollable products), averaging Tier 3.4, with prior authorization required on 38.7% of covering formularies.
- 100%
- Plan coverage
- 5,052
- Plans covering
- T3.4
- Avg tier
- 38.7%
- Prior auth required
What the CMS Formulary Data Shows for 24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima]
Per the CMS 2026 Part D formulary file, 24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima] (RxNorm concept RXCUI 1433235, generic name 24) appears on 328 distinct formulary files spanning 5,052 Medicare Part D plan offerings - 100% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 3.4.
Real-world access to 24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima] depends on utilization management as much as tier placement: 38.7% of covering formularies require prior authorization. 34.8% require step therapy. 95.1% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 6,280 Part D beneficiaries filled 24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima] in 2023, with total plan-and-beneficiary spending of $29,339,819 and an average per-beneficiary annual cost of $4,671.95. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima] today.
Coverage Details
- Formularies covering
- 328
- Plans covering
- 5,052
- Coverage rate
- 100%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 38.7% of formularies
- Step therapy required
- 34.8% of formularies
- Quantity limits
- 95.1% of formularies
2023 Medicare Spending
- Beneficiaries
- 6,280
- Total spending
- $29,339,819
- Avg per beneficiary
- $4,671.95
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| 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 |
Show the next 30 plans
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | No | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | Yes | $0 | AL |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | No | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | No | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | No | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | No | $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 |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | No | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | No | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | No | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | No | $0 | NY |
| 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 |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | No | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | No | $0 | AR |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima] covered by Medicare Part D?
Yes, 24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima] is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).
What tier is 24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima] on Medicare Part D plans?
24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima] averages Tier 3.4 across Part D plans, ranging from Tier 1 to Tier 4.
Does 24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima] require prior authorization?
38.7% of Part D formularies require prior authorization for 24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima]. Step therapy: 34.8%. Quantity limits: 95.1%.
How much does Medicare spend on 24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima]?
In 2023, total Medicare Part D spending on 24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima] was $29,339,819, covering 6,280 beneficiaries. The average spend per beneficiary was $4,671.95.
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
- {2 (24 HR levomilnacipran 20 MG Extended Release Oral Capsule [Fetzima]) / 26 (24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima]) } Pack [Fetzima Pack] T3.4
- isocarboxazid 10 MG Oral Tablet [Marplan] T3.4
- methotrexate 2 MG/ML Oral Solution [Jylamvo] T3.4
- azilsartan medoxomil 40 MG / chlorthalidone 12.5 MG Oral Tablet [Edarbyclor] T3.4
- artemether 20 MG / lumefantrine 120 MG Oral Tablet [Coartem] T3.4
- nicotine 0.5 MG/ACTUAT Metered Dose Nasal Spray [Nicotrol] T3.4
Similar prior-authorization rate
- dexmethylphenidate hydrochloride 5 MG Oral Tablet 39.1% PA
- dexmethylphenidate hydrochloride 10 MG Oral Tablet 39.1% PA
- brexpiprazole 0.25 MG Oral Tablet [Rexulti] 38.1% PA
- tiopronin 100 MG Oral Tablet 39.4% PA
- perampanel 0.5 MG/ML Oral Suspension 39.5% PA
- perampanel 4 MG Oral Tablet 39.6% PA