{5 (milnacipran hydrochloride 12.5 MG Oral Tablet [Savella]) / 8 (milnacipran hydrochloride 25 MG Oral Tablet [Savella]) / 42 (milnacipran hydrochloride 50 MG Oral Tablet [Savella]) } Pack [Savella 4-Week Titration]
milnacipran hydrochloride
RxCUI: 833151
What the CMS Formulary Data Shows for {5 (milnacipran hydrochloride 12.5 MG Oral Tablet [Savella]) / 8 (milnacipran hydrochloride 25 MG Oral Tablet [Savella]) / 42 (milnacipran hydrochloride 50 MG Oral Tablet [Savella]) } Pack [Savella 4-Week Titration]
Per the CMS 2026 Part D formulary file, {5 (milnacipran hydrochloride 12.5 MG Oral Tablet [Savella]) / 8 (milnacipran hydrochloride 25 MG Oral Tablet [Savella]) / 42 (milnacipran hydrochloride 50 MG Oral Tablet [Savella]) } Pack [Savella 4-Week Titration] (RxNorm concept RXCUI 833151, generic name milnacipran hydrochloride) appears on 93 distinct formulary files spanning 1,673 Medicare Part D plan offerings - 33% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.9.
Real-world access to {5 (milnacipran hydrochloride 12.5 MG Oral Tablet [Savella]) / 8 (milnacipran hydrochloride 25 MG Oral Tablet [Savella]) / 42 (milnacipran hydrochloride 50 MG Oral Tablet [Savella]) } Pack [Savella 4-Week Titration] depends on utilization management as much as tier placement: 11.8% of covering formularies require prior authorization. 14% require step therapy. 68.8% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 16,373 Part D beneficiaries filled {5 (milnacipran hydrochloride 12.5 MG Oral Tablet [Savella]) / 8 (milnacipran hydrochloride 25 MG Oral Tablet [Savella]) / 42 (milnacipran hydrochloride 50 MG Oral Tablet [Savella]) } Pack [Savella 4-Week Titration] in 2023, with total plan-and-beneficiary spending of $61,126,083 and an average per-beneficiary annual cost of $3,733.35. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry {5 (milnacipran hydrochloride 12.5 MG Oral Tablet [Savella]) / 8 (milnacipran hydrochloride 25 MG Oral Tablet [Savella]) / 42 (milnacipran hydrochloride 50 MG Oral Tablet [Savella]) } Pack [Savella 4-Week Titration] today.
Coverage Details
- Formularies covering
- 93
- Plans covering
- 1,673
- Coverage rate
- 33%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 11.8% of formularies
- Step therapy required
- 14% of formularies
- Quantity limits
- 68.8% of formularies
2023 Medicare Spending
- Beneficiaries
- 16,373
- Total spending
- $61,126,083
- Avg per beneficiary
- $3,733.35
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering {5 (milnacipran hydrochloride 12.5 MG Oral Tablet [Savella]) / 8 (milnacipran hydrochloride 25 MG Oral Tablet [Savella]) / 42 (milnacipran hydrochloride 50 MG Oral Tablet [Savella]) } Pack [Savella 4-Week Titration]
5 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T3 | No | No | $0 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T3 | No | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T3 | No | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T3 | No | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T3 | No | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering {5 (milnacipran hydrochloride 12.5 MG Oral Tablet [Savella]) / 8 (milnacipran hydrochloride 25 MG Oral Tablet [Savella]) / 42 (milnacipran hydrochloride 50 MG Oral Tablet [Savella]) } Pack [Savella 4-Week Titration]
95 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| 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 |
| 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 |
| 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 |
| 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 Maryland Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $0 | MD |
| Provider Partners Missouri Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $0 | MO |
| 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 |
| Tufts Health One Care (HMO D-SNP) | TUFTS HEALTH PUBLIC PLANS, INC. | T1 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | TUFTS HEALTH PUBLIC PLANS, INC. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION | T1 | No | $0 | MA |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF FLORIDA, INC. | T1 | No | $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 |
| 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 |
| WellSense Added Value (HMO) | BOSTON MEDICAL CENTER HEALTH PLAN, INC. | T1 | No | $21.70 | NH |
| Provider Partners Maryland Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $31.20 | MD |
| Provider Partners Maryland Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $31.20 | MD |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $32.70 | PA |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $32.70 | PA |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF COLORADO, INC. | T1 | No | $35.20 | CO |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC. | T1 | No | $36.20 | NC |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $36.20 | NC |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $36.20 | NC |
| Provider Partners Indiana Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $38.40 | IN |
| Provider Partners Indiana Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $38.40 | IN |
| Provider Partners Kentucky Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF KENTUCKY | T1 | No | $38.40 | KY |
| Longevity Health Plan (PPO I-SNP) | LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP | T1 | No | $40.00 | NJ |
| Provider Partners Missouri Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $43.00 | MO |
| Provider Partners Missouri Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $43.00 | MO |
| ElderServe Star (HMO I-SNP) | ELDERSERVE HEALTH, INC. | T1 | No | $58.80 | NY |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF NEW YORK, INC. | T1 | No | $58.80 | NY |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| Leon MediExtra (HMO) | LEON HEALTH, INC. | T2 | No | $0 | FL |
| Leon MediDual (HMO D-SNP) | LEON HEALTH, INC. | T2 | No | $0 | FL |
| Leon MediMore (HMO) | LEON HEALTH, INC. | T2 | No | $0 | FL |
| Leon MediMax (HMO D-SNP) | LEON HEALTH, INC. | T2 | No | $0 | FL |
| UHC Dual Complete IA-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T3 | No | $0 | IA |
| UHC Dual Complete MO-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T3 | No | $0 | MO |
Frequently Asked Questions
Is {5 (milnacipran hydrochloride 12.5 MG Oral Tablet [Savella]) / 8 (milnacipran hydrochloride 25 MG Oral Tablet [Savella]) / 42 (milnacipran hydrochloride 50 MG Oral Tablet [Savella]) } Pack [Savella 4-Week Titration] covered by Medicare Part D?
Yes, {5 (milnacipran hydrochloride 12.5 MG Oral Tablet [Savella]) / 8 (milnacipran hydrochloride 25 MG Oral Tablet [Savella]) / 42 (milnacipran hydrochloride 50 MG Oral Tablet [Savella]) } Pack [Savella 4-Week Titration] is covered by 1,673 Medicare Part D plans (33% of all Part D formularies).
What tier is {5 (milnacipran hydrochloride 12.5 MG Oral Tablet [Savella]) / 8 (milnacipran hydrochloride 25 MG Oral Tablet [Savella]) / 42 (milnacipran hydrochloride 50 MG Oral Tablet [Savella]) } Pack [Savella 4-Week Titration] on Medicare Part D plans?
{5 (milnacipran hydrochloride 12.5 MG Oral Tablet [Savella]) / 8 (milnacipran hydrochloride 25 MG Oral Tablet [Savella]) / 42 (milnacipran hydrochloride 50 MG Oral Tablet [Savella]) } Pack [Savella 4-Week Titration] averages Tier 2.9 across Part D plans, ranging from Tier 1 to Tier 4.
Does {5 (milnacipran hydrochloride 12.5 MG Oral Tablet [Savella]) / 8 (milnacipran hydrochloride 25 MG Oral Tablet [Savella]) / 42 (milnacipran hydrochloride 50 MG Oral Tablet [Savella]) } Pack [Savella 4-Week Titration] require prior authorization?
11.8% of Part D formularies require prior authorization for {5 (milnacipran hydrochloride 12.5 MG Oral Tablet [Savella]) / 8 (milnacipran hydrochloride 25 MG Oral Tablet [Savella]) / 42 (milnacipran hydrochloride 50 MG Oral Tablet [Savella]) } Pack [Savella 4-Week Titration]. Step therapy: 14%. Quantity limits: 68.8%.
How much does Medicare spend on {5 (milnacipran hydrochloride 12.5 MG Oral Tablet [Savella]) / 8 (milnacipran hydrochloride 25 MG Oral Tablet [Savella]) / 42 (milnacipran hydrochloride 50 MG Oral Tablet [Savella]) } Pack [Savella 4-Week Titration]?
In 2023, total Medicare Part D spending on {5 (milnacipran hydrochloride 12.5 MG Oral Tablet [Savella]) / 8 (milnacipran hydrochloride 25 MG Oral Tablet [Savella]) / 42 (milnacipran hydrochloride 50 MG Oral Tablet [Savella]) } Pack [Savella 4-Week Titration] was $61,126,083, covering 16,373 beneficiaries. The average spend per beneficiary was $3,733.35.
Read our methodology - how this data is sourced, computed, and verified.