Medicare Part D coverage · eliglustat · RxCUI 1547231
eliglustat 84 MG Oral Capsule [Cerdelga]
Per the CMS 2026 Part D formulary file, eliglustat 84 MG Oral Capsule [Cerdelga] is covered by 1,807 Medicare Part D plans (35.8% of enrollable products), averaging Tier 4.4, with prior authorization required on 96.9% of covering formularies.
- 35.8%
- Plan coverage
- 1,807
- Plans covering
- T4.4
- Avg tier
- 96.9%
- Prior auth required
What the CMS Formulary Data Shows for eliglustat 84 MG Oral Capsule [Cerdelga]
Per the CMS 2026 Part D formulary file, eliglustat 84 MG Oral Capsule [Cerdelga] (RxNorm concept RXCUI 1547231, generic name eliglustat) appears on 129 distinct formulary files spanning 1,807 Medicare Part D plan offerings - 35.8% 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 4.4.
Real-world access to eliglustat 84 MG Oral Capsule [Cerdelga] depends on utilization management as much as tier placement: 96.9% of covering formularies require prior authorization. 0% require step therapy. 10.1% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 119 Part D beneficiaries filled eliglustat 84 MG Oral Capsule [Cerdelga] in 2023, with total plan-and-beneficiary spending of $37,570,025 and an average per-beneficiary annual cost of $315,714.50. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry eliglustat 84 MG Oral Capsule [Cerdelga] today.
Coverage Details
- Formularies covering
- 129
- Plans covering
- 1,807
- Coverage rate
- 35.8%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 96.9% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 10.1% of formularies
2023 Medicare Spending
- Beneficiaries
- 119
- Total spending
- $37,570,025
- Avg per beneficiary
- $315,714.50
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering eliglustat 84 MG Oral Capsule [Cerdelga]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| 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 |
| 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 |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| 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 |
| 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 |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $0 | PA |
Show the next 30 plans
| 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 |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Florida Complete Care (HMO I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | Yes | $4.80 | TX |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Illinois | T1 | Yes | $15.20 | IL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | Yes | $17.00 | AZ |
| Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $22.70 | NY |
| VIVA Medicare Extra Value (HMO D-SNP) | Viva Health, Inc. | T1 | Yes | $27.70 | AL |
| VIVA Medicare Extra Care (HMO D-SNP) | Viva Health, Inc. | T1 | Yes | $27.70 | AL |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $32.70 | PA |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $32.70 | PA |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | Yes | $36.20 | NC |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | Yes | $36.20 | NC |
| Provider Partners Indiana Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | Yes | $38.40 | IN |
| Provider Partners Indiana Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | Yes | $38.40 | IN |
| Provider Partners Kentucky Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Kentucky | T1 | Yes | $38.40 | KY |
| Provider Partners Missouri Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $43.00 | MO |
| Provider Partners Missouri Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $43.00 | MO |
| Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) | Elderplan, Inc. | T1 | Yes | $44.80 | NY |
| MetroPlus Platinum Plan (HMO) | Metroplus Health Plan, Inc. | T1 | Yes | $58.80 | NY |
| 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 |
| Aetna Medicare Signature (HMO) | Aetna Health OF California Inc. | T5 | Yes | $0 | CA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is eliglustat 84 MG Oral Capsule [Cerdelga] covered by Medicare Part D?
Yes, eliglustat 84 MG Oral Capsule [Cerdelga] is covered by 1,807 Medicare Part D plans (35.8% of all Part D formularies).
What tier is eliglustat 84 MG Oral Capsule [Cerdelga] on Medicare Part D plans?
eliglustat 84 MG Oral Capsule [Cerdelga] averages Tier 4.4 across Part D plans, ranging from Tier 1 to Tier 6.
Does eliglustat 84 MG Oral Capsule [Cerdelga] require prior authorization?
96.9% of Part D formularies require prior authorization for eliglustat 84 MG Oral Capsule [Cerdelga]. Step therapy: 0%. Quantity limits: 10.1%.
How much does Medicare spend on eliglustat 84 MG Oral Capsule [Cerdelga]?
In 2023, total Medicare Part D spending on eliglustat 84 MG Oral Capsule [Cerdelga] was $37,570,025, covering 119 beneficiaries. The average spend per beneficiary was $315,714.50.
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
- cysteamine 4.4 MG/ML Ophthalmic Solution [Cystaran] T4.4
- ceftaroline fosamil 600 MG Injection [Teflaro] T4.4
- sapropterin dihydrochloride 500 MG Powder for Oral Solution [Zelvysia] T4.4
- {28 (alpelisib 50 MG Oral Granules [Vijoice]) } Pack [Vijoice 50 MG Granules 28 Day] T4.4
- sofosbuvir 200 MG Oral Tablet [Sovaldi] T4.4
- sinecatechins 0.15 MG/MG Topical Ointment [Veregen] T4.4
Similar prior-authorization rate
- pegvisomant 30 MG Injection [Somavert] 96.9% PA
- erlotinib 100 MG Oral Tablet 97% PA
- cysteamine 3.8 MG/ML Ophthalmic Solution [Cystadrops] 97% PA
- erlotinib 150 MG Oral Tablet 97% PA
- 5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo] 97% PA
- treprostinil 0.0265 MG Inhalation Powder [Yutrepia] 97% PA