Medicare Part D coverage · elagolix · RxCUI 2049862
elagolix 200 MG Oral Tablet [Orilissa]
Per the CMS 2026 Part D formulary file, elagolix 200 MG Oral Tablet [Orilissa] is covered by 333 Medicare Part D plans (6.6% of enrollable products), averaging Tier 4.2, with prior authorization required on 95.9% of covering formularies.
- 6.6%
- Plan coverage
- 333
- Plans covering
- T4.2
- Avg tier
- 95.9%
- Prior auth required
What the CMS Formulary Data Shows for elagolix 200 MG Oral Tablet [Orilissa]
Per the CMS 2026 Part D formulary file, elagolix 200 MG Oral Tablet [Orilissa] (RxNorm concept RXCUI 2049862, generic name elagolix) appears on 74 distinct formulary files spanning 333 Medicare Part D plan offerings - 6.6% 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 4.2.
Real-world access to elagolix 200 MG Oral Tablet [Orilissa] depends on utilization management as much as tier placement: 95.9% of covering formularies require prior authorization. 0% require step therapy. 77% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 66 Part D beneficiaries filled elagolix 200 MG Oral Tablet [Orilissa] in 2023, with total plan-and-beneficiary spending of $404,034 and an average per-beneficiary annual cost of $6,121.73. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry elagolix 200 MG Oral Tablet [Orilissa] today.
Coverage Details
- Formularies covering
- 74
- Plans covering
- 333
- Coverage rate
- 6.6%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 95.9% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 77% of formularies
2023 Medicare Spending
- Beneficiaries
- 66
- Total spending
- $404,034
- Avg per beneficiary
- $6,121.73
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering elagolix 200 MG Oral Tablet [Orilissa]
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 |
| 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 |
| 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 |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $0 | KY, TN |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | Yes | $17.00 | AZ |
| Alterwood Advantage Dual Value (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $31.20 | MD |
| Valor Health Plan (HMO I-SNP) | TSG Guard, Inc. | T1 | Yes | $31.40 | OH |
| WV Senior Advantage (HMO I-SNP) | West Virginia Senior Advantage, Inc. | T1 | Yes | $32.70 | WV |
| Abilis Health (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $35.90 | KY, TN |
Show the next 30 plans
| CommuniCare Advantage ISNP (HMO I-SNP) | OH CHS SNP Inc. | T1 | Yes | $38.40 | IN, MD, OH |
| Nascentia Skilled Nursing Facility (HMO I-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $58.80 | NY |
| FHCP Medicare Classic (HMO) | Florida Blue Medicare, Inc. | T3 | Yes | $0 | FL |
| FHCP Medicare Rx Plus (HMO-POS) | Florida Blue Medicare, Inc. | T3 | Yes | $49.00 | FL |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T4 | Yes | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T4 | Yes | $0 | NY |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS Choice | T4 | Yes | $51.60 | NY |
| 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 |
| Medicare BlueEssential (PPO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Medicare BlueActive (PPO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Medicare BlueVital (PPO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Univera SeniorChoice Basic (HMO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Univera SeniorChoice Extra (HMO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Medicare Blue Choice Core (HMO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Univera Medicare Dual (HMO D-SNP) | Excellus Health Plan Community Care LLC | T5 | Yes | $0 | NY |
| Medicare Blue Dual (HMO D-SNP) | Excellus Health Plan Community Care LLC | T5 | Yes | $0 | NY |
| Network Health Select (PPO) | Network Health Insurance Corporation | T5 | No | $0 | WI |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is elagolix 200 MG Oral Tablet [Orilissa] covered by Medicare Part D?
Yes, elagolix 200 MG Oral Tablet [Orilissa] is covered by 333 Medicare Part D plans (6.6% of all Part D formularies).
What tier is elagolix 200 MG Oral Tablet [Orilissa] on Medicare Part D plans?
elagolix 200 MG Oral Tablet [Orilissa] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 5.
Does elagolix 200 MG Oral Tablet [Orilissa] require prior authorization?
95.9% of Part D formularies require prior authorization for elagolix 200 MG Oral Tablet [Orilissa]. Step therapy: 0%. Quantity limits: 77%.
How much does Medicare spend on elagolix 200 MG Oral Tablet [Orilissa]?
In 2023, total Medicare Part D spending on elagolix 200 MG Oral Tablet [Orilissa] was $404,034, covering 66 beneficiaries. The average spend per beneficiary was $6,121.73.
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
- 24 HR selegiline 0.25 MG/HR Transdermal System [Emsam] T4.2
- lotilaner 2.5 MG/ML Ophthalmic Solution [Xdemvy] T4.2
- glutamine 5000 MG Powder for Oral Solution T4.2
- 1.7 ML denosumab-bbdz 70 MG/ML Injection [Wyost] T4.2
- {4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack] T4.2
- apremilast 20 MG Oral Tablet [Otezla] T4.2
Similar prior-authorization rate
- etrasimod 2 MG Oral Tablet [Velsipity] 95.9% PA
- voriconazole 200 MG Injection 96% PA
- mechlorethamine 0.00016 MG/MG Topical Gel [Valchlor] 96% PA
- deflazacort 22.75 MG/ML Oral Suspension 95.8% PA
- sapropterin dihydrochloride 100 MG Powder for Oral Solution 95.8% PA
- sapropterin dihydrochloride 500 MG Powder for Oral Solution [Zelvysia] 96.1% PA