berotralstat 150 MG Oral Capsule [Orladeyo]
berotralstat
RxCUI: 2467571
What the CMS Formulary Data Shows for berotralstat 150 MG Oral Capsule [Orladeyo]
Per the CMS 2026 Part D formulary file, berotralstat 150 MG Oral Capsule [Orladeyo] (RxNorm concept RXCUI 2467571, generic name berotralstat) appears on 24 distinct formulary files spanning 113 Medicare Part D plan offerings - 2.2% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 4.6.
Real-world access to berotralstat 150 MG Oral Capsule [Orladeyo] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 45.8% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 158 Part D beneficiaries filled berotralstat 150 MG Oral Capsule [Orladeyo] in 2023, with total plan-and-beneficiary spending of $52,329,473 and an average per-beneficiary annual cost of $331,199.19. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry berotralstat 150 MG Oral Capsule [Orladeyo] today.
Coverage Details
- Formularies covering
- 24
- Plans covering
- 113
- Coverage rate
- 2.2%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 5, Specialty
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 45.8% of formularies
2023 Medicare Spending
- Beneficiaries
- 158
- Total spending
- $52,329,473
- Avg per beneficiary
- $331,199.19
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering berotralstat 150 MG Oral Capsule [Orladeyo]
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 |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Flex (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Active (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Select Health Medicare Wellness (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Providence Medicare Extra Part B Only + Rx (HMO) | PROVIDENCE HEALTH ASSURANCE | T5 | Yes | $0 | OR |
| Providence Medicare Prime + Rx (HMO) | PROVIDENCE HEALTH ASSURANCE | T5 | Yes | $0 | OR |
| Providence Medicare Dual Plus (HMO D-SNP) | PROVIDENCE HEALTH ASSURANCE | T5 | Yes | $0 | OR |
| Providence Medicare Timber + Rx (HMO) | PROVIDENCE HEALTH ASSURANCE | T5 | Yes | $0 | OR, WA |
| Providence Medicare Pine + Rx (HMO) | PROVIDENCE HEALTH ASSURANCE | T5 | Yes | $0 | WA |
| Providence Medicare Extra + Rx (HMO) | PROVIDENCE HEALTH ASSURANCE | T5 | Yes | $0 | OR, WA |
| Providence Medicare Sycamore + Rx (HMO) | PROVIDENCE HEALTH ASSURANCE | T5 | Yes | $0 | CA |
| Geisinger Gold Preferred Complete Rx (PPO) | GEISINGER INDEMNITY INSURANCE COMPANY | T5 | Yes | $0 | PA |
| Geisinger Gold Secure Rx (HMO D-SNP) | GEISINGER HEALTH PLAN | T5 | Yes | $0 | PA |
| Geisinger Gold Classic 360 Rx (HMO) | GEISINGER HEALTH PLAN | T5 | Yes | $0 | PA |
| Geisinger Gold Classic Essential Rx (HMO) | GEISINGER HEALTH PLAN | T5 | Yes | $0 | PA |
| UPMC for Life HMO Premier Rx (HMO) | UPMC HEALTH PLAN, INC. | T5 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC FOR YOU, INC | T5 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC FOR YOU, INC | T5 | Yes | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $0 | PA |
| UPMC for Life PPO Essential Care Rx (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC HEALTH COVERAGE, INC. | T5 | Yes | $0 | PA |
| Troy Medicare (HMO) | TROY HEALTH, INC. | T5 | Yes | $0 | NC |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | TROY HEALTH, INC. | T5 | Yes | $0 | NC |
| Contra Costa Health Care Plus (HMO D-SNP) | CONTRA COSTA COUNTY MEDICAL SERVICE DBA CONTRA COSTA HEALTH | T5 | Yes | $0 | CA |
| Keystone First VIP Choice (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T5 | Yes | $0 | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T5 | Yes | $0 | PA |
| First Choice VIP Care (HMO D-SNP) | SELECT HEALTH OF SOUTH CAROLINA, INC. | T5 | Yes | $0 | SC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T5 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T5 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS FLORIDA INC | T5 | Yes | $0 | FL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS LOUISIANA, INC. | T5 | Yes | $0 | LA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH MICHIGAN, INC. | T5 | Yes | $0 | MI |
| Healthy Mississippi Premier Advantage (HMO-POS) | Healthy Mississippi, Inc. | T5 | Yes | $0 | MS |
| Health First Rewards H1099-014 (HMO) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $0 | FL |
Frequently Asked Questions
Is berotralstat 150 MG Oral Capsule [Orladeyo] covered by Medicare Part D?
Yes, berotralstat 150 MG Oral Capsule [Orladeyo] is covered by 113 Medicare Part D plans (2.2% of all Part D formularies).
What tier is berotralstat 150 MG Oral Capsule [Orladeyo] on Medicare Part D plans?
berotralstat 150 MG Oral Capsule [Orladeyo] averages Tier 4.6 across Part D plans, ranging from Tier 1 to Tier 6.
Does berotralstat 150 MG Oral Capsule [Orladeyo] require prior authorization?
100% of Part D formularies require prior authorization for berotralstat 150 MG Oral Capsule [Orladeyo]. Step therapy: 0%. Quantity limits: 45.8%.
How much does Medicare spend on berotralstat 150 MG Oral Capsule [Orladeyo]?
In 2023, total Medicare Part D spending on berotralstat 150 MG Oral Capsule [Orladeyo] was $52,329,473, covering 158 beneficiaries. The average spend per beneficiary was $331,199.19.
Read our methodology - how this data is sourced, computed, and verified.