Medicare Part D coverage · droxidopa · RxCUI 1490026
droxidopa 100 MG Oral Capsule
Per the CMS 2026 Part D formulary file, droxidopa 100 MG Oral Capsule is covered by 3,858 Medicare Part D plans (76.4% of enrollable products), averaging Tier 3, with prior authorization required on 96.2% of covering formularies.
- 76.4%
- Plan coverage
- 3,858
- Plans covering
- T3
- Avg tier
- 96.2%
- Prior auth required
What the CMS Formulary Data Shows for droxidopa 100 MG Oral Capsule
Per the CMS 2026 Part D formulary file, droxidopa 100 MG Oral Capsule (RxNorm concept RXCUI 1490026, generic name droxidopa) appears on 312 distinct formulary files spanning 3,858 Medicare Part D plan offerings - 76.4% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 3.
Real-world access to droxidopa 100 MG Oral Capsule depends on utilization management as much as tier placement: 96.2% of covering formularies require prior authorization. 0% require step therapy. 63.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 5,473 Part D beneficiaries filled droxidopa 100 MG Oral Capsule in 2023, with total plan-and-beneficiary spending of $65,728,105 and an average per-beneficiary annual cost of $12,009.52. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry droxidopa 100 MG Oral Capsule today.
Coverage Details
- Formularies covering
- 312
- Plans covering
- 3,858
- Coverage rate
- 76.4%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 96.2% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 63.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 5,473
- Total spending
- $65,728,105
- Avg per beneficiary
- $12,009.52
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering droxidopa 100 MG Oral Capsule
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | Yes | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | Yes | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | Yes | $0 | NJ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | Yes | $0 | NY |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | Yes | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | Yes | $0 | GA |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
Show the next 30 plans
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | Yes | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | Yes | $0 | AL |
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T1 | Yes | $0 | CA |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | Yes | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | Yes | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| 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 |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T1 | Yes | $0 | CA |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | Yes | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | Yes | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| DualConnect (HMO D-SNP) | Santa Clara County Health Authority | T1 | Yes | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T1 | Yes | $0 | NY |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $0 | NY |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | Yes | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | Yes | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $0 | MO |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $0 | KY, TN |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is droxidopa 100 MG Oral Capsule covered by Medicare Part D?
Yes, droxidopa 100 MG Oral Capsule is covered by 3,858 Medicare Part D plans (76.4% of all Part D formularies).
What tier is droxidopa 100 MG Oral Capsule on Medicare Part D plans?
droxidopa 100 MG Oral Capsule averages Tier 3 across Part D plans, ranging from Tier 1 to Tier 5.
Does droxidopa 100 MG Oral Capsule require prior authorization?
96.2% of Part D formularies require prior authorization for droxidopa 100 MG Oral Capsule. Step therapy: 0%. Quantity limits: 63.5%.
How much does Medicare spend on droxidopa 100 MG Oral Capsule?
In 2023, total Medicare Part D spending on droxidopa 100 MG Oral Capsule was $65,728,105, covering 5,473 beneficiaries. The average spend per beneficiary was $12,009.52.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
Similar prior-authorization rate
- dasatinib 100 MG Oral Tablet [Phyrago] 96.2% PA
- deflazacort 6 MG Oral Tablet 96.2% PA
- solriamfetol 75 MG Oral Tablet [Sunosi] 96.2% PA
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- sapropterin dihydrochloride 500 MG Powder for Oral Solution [Zelvysia] 96.1% PA
- amifampridine 10 MG Oral Tablet [Firdapse] 96.4% PA