clozapine 100 MG Oral Tablet [Clozaril]
clozapine
RxCUI: 104776
What the CMS Formulary Data Shows for clozapine 100 MG Oral Tablet [Clozaril]
Per the CMS 2026 Part D formulary file, clozapine 100 MG Oral Tablet [Clozaril] (RxNorm concept RXCUI 104776, generic name clozapine) appears on 1 distinct formulary file spanning 2 Medicare Part D plan offerings - 0% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 1, with a cross-plan average of Tier 1.
Real-world access to clozapine 100 MG Oral Tablet [Clozaril] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 100% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 64,860 Part D beneficiaries filled clozapine 100 MG Oral Tablet [Clozaril] in 2023, with total plan-and-beneficiary spending of $85,570,390 and an average per-beneficiary annual cost of $1,319.31. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry clozapine 100 MG Oral Tablet [Clozaril] today.
Coverage Details
- Formularies covering
- 1
- Plans covering
- 2
- Coverage rate
- 0%
- Tier range
- Tier 1, Preferred Generic
- Average tier
- Tier 1, Preferred Generic
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 100% of formularies
2023 Medicare Spending
- Beneficiaries
- 64,860
- Total spending
- $85,570,390
- Avg per beneficiary
- $1,319.31
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering clozapine 100 MG Oral Tablet [Clozaril]
2 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 |
Frequently Asked Questions
Is clozapine 100 MG Oral Tablet [Clozaril] covered by Medicare Part D?
Yes, clozapine 100 MG Oral Tablet [Clozaril] is covered by 2 Medicare Part D plans (0% of all Part D formularies).
What tier is clozapine 100 MG Oral Tablet [Clozaril] on Medicare Part D plans?
clozapine 100 MG Oral Tablet [Clozaril] averages Tier 1 across Part D plans, ranging from Tier 1 to Tier 1.
Does clozapine 100 MG Oral Tablet [Clozaril] require prior authorization?
100% of Part D formularies require prior authorization for clozapine 100 MG Oral Tablet [Clozaril]. Step therapy: 0%. Quantity limits: 100%.
How much does Medicare spend on clozapine 100 MG Oral Tablet [Clozaril]?
In 2023, total Medicare Part D spending on clozapine 100 MG Oral Tablet [Clozaril] was $85,570,390, covering 64,860 beneficiaries. The average spend per beneficiary was $1,319.31.
Read our methodology - how this data is sourced, computed, and verified.