ambrisentan 5 MG Oral Tablet [Letairis]
ambrisentan
RxCUI: 722124
What the CMS Formulary Data Shows for ambrisentan 5 MG Oral Tablet [Letairis]
Per the CMS 2026 Part D formulary file, ambrisentan 5 MG Oral Tablet [Letairis] (RxNorm concept RXCUI 722124, generic name ambrisentan) appears on 2 distinct formulary files spanning 8 Medicare Part D plan offerings - 0.2% 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 3.
Real-world access to ambrisentan 5 MG Oral Tablet [Letairis] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 50% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 6,456 Part D beneficiaries filled ambrisentan 5 MG Oral Tablet [Letairis] in 2023, with total plan-and-beneficiary spending of $246,059,319 and an average per-beneficiary annual cost of $38,113.28. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry ambrisentan 5 MG Oral Tablet [Letairis] today.
Coverage Details
- Formularies covering
- 2
- Plans covering
- 8
- Coverage rate
- 0.2%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 50% of formularies
2023 Medicare Spending
- Beneficiaries
- 6,456
- Total spending
- $246,059,319
- Avg per beneficiary
- $38,113.28
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering ambrisentan 5 MG Oral Tablet [Letairis]
8 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $0 | NY |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $34.50 | NY |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | Yes | $47.00 | PA |
| Keystone 65 Preferred Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | Yes | $59.70 | PA |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | Yes | $63.50 | PA |
| Keystone 65 Preferred Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | Yes | $79.70 | PA |
| Personal Choice 65 Rx (PPO) | QCC INSURANCE COMPANY | T5 | Yes | $102.20 | PA |
| Personal Choice 65 Rx (PPO) | QCC INSURANCE COMPANY | T5 | Yes | $112.70 | PA |
Frequently Asked Questions
Is ambrisentan 5 MG Oral Tablet [Letairis] covered by Medicare Part D?
Yes, ambrisentan 5 MG Oral Tablet [Letairis] is covered by 8 Medicare Part D plans (0.2% of all Part D formularies).
What tier is ambrisentan 5 MG Oral Tablet [Letairis] on Medicare Part D plans?
ambrisentan 5 MG Oral Tablet [Letairis] averages Tier 3 across Part D plans, ranging from Tier 1 to Tier 5.
Does ambrisentan 5 MG Oral Tablet [Letairis] require prior authorization?
100% of Part D formularies require prior authorization for ambrisentan 5 MG Oral Tablet [Letairis]. Step therapy: 0%. Quantity limits: 50%.
How much does Medicare spend on ambrisentan 5 MG Oral Tablet [Letairis]?
In 2023, total Medicare Part D spending on ambrisentan 5 MG Oral Tablet [Letairis] was $246,059,319, covering 6,456 beneficiaries. The average spend per beneficiary was $38,113.28.
Read our methodology - how this data is sourced, computed, and verified.