calcium oxybate 234 MG/ML / magnesium oxybate 96 MG/ML / potassium oxybate 130 MG/ML / sodium oxybate 40 MG/ML Oral Solution [Xywav]
calcium oxybate
RxCUI: 2393794
What the CMS Formulary Data Shows for calcium oxybate 234 MG/ML / magnesium oxybate 96 MG/ML / potassium oxybate 130 MG/ML / sodium oxybate 40 MG/ML Oral Solution [Xywav]
Per the CMS 2026 Part D formulary file, calcium oxybate 234 MG/ML / magnesium oxybate 96 MG/ML / potassium oxybate 130 MG/ML / sodium oxybate 40 MG/ML Oral Solution [Xywav] (RxNorm concept RXCUI 2393794, generic name calcium oxybate) appears on 18 distinct formulary files spanning 125 Medicare Part D plan offerings - 2.5% 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 4.3.
Real-world access to calcium oxybate 234 MG/ML / magnesium oxybate 96 MG/ML / potassium oxybate 130 MG/ML / sodium oxybate 40 MG/ML Oral Solution [Xywav] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 27.8% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 108,459 Part D beneficiaries filled calcium oxybate 234 MG/ML / magnesium oxybate 96 MG/ML / potassium oxybate 130 MG/ML / sodium oxybate 40 MG/ML Oral Solution [Xywav] in 2023, with total plan-and-beneficiary spending of $35,814,449 and an average per-beneficiary annual cost of $330.21. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry calcium oxybate 234 MG/ML / magnesium oxybate 96 MG/ML / potassium oxybate 130 MG/ML / sodium oxybate 40 MG/ML Oral Solution [Xywav] today.
Coverage Details
- Formularies covering
- 18
- Plans covering
- 125
- Coverage rate
- 2.5%
- 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
- 27.8% of formularies
2023 Medicare Spending
- Beneficiaries
- 108,459
- Total spending
- $35,814,449
- Avg per beneficiary
- $330.21
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering calcium oxybate 234 MG/ML / magnesium oxybate 96 MG/ML / potassium oxybate 130 MG/ML / sodium oxybate 40 MG/ML Oral Solution [Xywav]
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 |
| BlueCare Plus (HMO D-SNP) | VOLUNTEER STATE HEALTH PLAN | T4 | Yes | $0 | TN |
| BlueCare Plus Choice (HMO D-SNP) | VOLUNTEER STATE HEALTH PLAN | T4 | Yes | $0 | TN |
| BlueCare Plus Select (HMO D-SNP) | VOLUNTEER STATE HEALTH PLAN | T4 | Yes | $0 | TN |
| BlueAdvantage Sapphire (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T5 | Yes | $0 | TN |
| BlueAdvantage Sapphire (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T5 | Yes | $0 | TN |
| BlueAdvantage Garnet (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T5 | Yes | $0 | TN |
| BlueAdvantage Garnet (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T5 | Yes | $0 | TN |
| BlueAdvantage Sapphire (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T5 | Yes | $0 | TN |
| BlueAdvantage Sapphire (PPO) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T5 | Yes | $0 | GA |
| BlueAdvantage Total Heart and Diabetes (PPO C-SNP) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T5 | Yes | $0 | GA, TN |
| BlueAdvantage Total Heart and Diabetes (PPO C-SNP) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | T5 | Yes | $0 | TN |
| 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 |
| 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 |
| SCAN Connections (HMO D-SNP) | SCAN HEALTH PLAN | T5 | Yes | $0 | CA |
| SCAN Connections at Home (HMO D-SNP) | SCAN HEALTH PLAN | T5 | Yes | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN NEVADA, INC. | T5 | Yes | $0 | NV |
| SCAN Balance (HMO C-SNP) | SCAN HEALTH PLAN NEVADA, INC. | T5 | Yes | $0 | NV |
| SCAN Strive (HMO C-SNP) | SCAN HEALTH PLAN NEVADA, INC. | T5 | Yes | $0 | NV |
| SCAN MyChoice (HMO) | SCAN HEALTH PLAN NEVADA, INC. | T5 | Yes | $0 | NV |
| SCAN Classic (HMO) | SCAN DESERT HEALTH PLAN, INC. | T5 | Yes | $0 | AZ |
| SCAN Balance (HMO C-SNP) | SCAN DESERT HEALTH PLAN, INC. | T5 | Yes | $0 | AZ |
| SCAN Embrace (HMO-POS I-SNP) | SCAN DESERT HEALTH PLAN, INC. | T5 | Yes | $0 | AZ |
| SCAN Strive (HMO C-SNP) | SCAN DESERT HEALTH PLAN, INC. | T5 | Yes | $0 | AZ |
| SCAN MyChoice (HMO) | SCAN DESERT HEALTH PLAN, INC. | T5 | Yes | $0 | AZ |
| SCAN Classic WA (HMO) | SCAN HEALTH PLAN (WA) | T5 | Yes | $0 | WA |
| SCAN MyChoice WA (HMO) | SCAN HEALTH PLAN (WA) | T5 | Yes | $0 | WA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN (NM) | T5 | Yes | $0 | NM |
| SCAN Balance (HMO C-SNP) | SCAN HEALTH PLAN (NM) | T5 | Yes | $0 | NM |
| SCAN Strive (HMO C-SNP) | SCAN HEALTH PLAN (NM) | T5 | Yes | $0 | NM |
| SCAN MyChoice (HMO) | SCAN HEALTH PLAN (NM) | T5 | Yes | $0 | NM |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T5 | Yes | $0 | CA |
| SCAN Classic (HMO) | SCAN HEALTH PLAN | T5 | Yes | $0 | CA |
Frequently Asked Questions
Is calcium oxybate 234 MG/ML / magnesium oxybate 96 MG/ML / potassium oxybate 130 MG/ML / sodium oxybate 40 MG/ML Oral Solution [Xywav] covered by Medicare Part D?
Yes, calcium oxybate 234 MG/ML / magnesium oxybate 96 MG/ML / potassium oxybate 130 MG/ML / sodium oxybate 40 MG/ML Oral Solution [Xywav] is covered by 125 Medicare Part D plans (2.5% of all Part D formularies).
What tier is calcium oxybate 234 MG/ML / magnesium oxybate 96 MG/ML / potassium oxybate 130 MG/ML / sodium oxybate 40 MG/ML Oral Solution [Xywav] on Medicare Part D plans?
calcium oxybate 234 MG/ML / magnesium oxybate 96 MG/ML / potassium oxybate 130 MG/ML / sodium oxybate 40 MG/ML Oral Solution [Xywav] averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 5.
Does calcium oxybate 234 MG/ML / magnesium oxybate 96 MG/ML / potassium oxybate 130 MG/ML / sodium oxybate 40 MG/ML Oral Solution [Xywav] require prior authorization?
100% of Part D formularies require prior authorization for calcium oxybate 234 MG/ML / magnesium oxybate 96 MG/ML / potassium oxybate 130 MG/ML / sodium oxybate 40 MG/ML Oral Solution [Xywav]. Step therapy: 0%. Quantity limits: 27.8%.
How much does Medicare spend on calcium oxybate 234 MG/ML / magnesium oxybate 96 MG/ML / potassium oxybate 130 MG/ML / sodium oxybate 40 MG/ML Oral Solution [Xywav]?
In 2023, total Medicare Part D spending on calcium oxybate 234 MG/ML / magnesium oxybate 96 MG/ML / potassium oxybate 130 MG/ML / sodium oxybate 40 MG/ML Oral Solution [Xywav] was $35,814,449, covering 108,459 beneficiaries. The average spend per beneficiary was $330.21.
Read our methodology - how this data is sourced, computed, and verified.