gefitinib 250 MG Oral Tablet [Iressa]
gefitinib
RxCUI: 402091
What the CMS Formulary Data Shows for gefitinib 250 MG Oral Tablet [Iressa]
Per the CMS 2026 Part D formulary file, gefitinib 250 MG Oral Tablet [Iressa] (RxNorm concept RXCUI 402091, generic name gefitinib) appears on 4 distinct formulary files spanning 22 Medicare Part D plan offerings - 0.4% 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 3.
Real-world access to gefitinib 250 MG Oral Tablet [Iressa] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 25% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 90 Part D beneficiaries filled gefitinib 250 MG Oral Tablet [Iressa] in 2023, with total plan-and-beneficiary spending of $3,529,858 and an average per-beneficiary annual cost of $39,220.65. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry gefitinib 250 MG Oral Tablet [Iressa] today.
Coverage Details
- Formularies covering
- 4
- Plans covering
- 22
- Coverage rate
- 0.4%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 25% of formularies
2023 Medicare Spending
- Beneficiaries
- 90
- Total spending
- $3,529,858
- Avg per beneficiary
- $39,220.65
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering gefitinib 250 MG Oral Tablet [Iressa]
22 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 |
| Platino Blindao (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| PLATINO ADVANCE (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| PLATINO PLUS (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $34.50 | NY |
| Health First Rewards H1099-014 (HMO) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $0 | FL |
| Health First SunSaver H1099-016 (HMO) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $0 | FL |
| Health First Complete Care H1099-023 (HMO) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $0 | FL |
| Health First Emerald Plus H1099-024 (HMO) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $0 | FL |
| Health First Premier Access H1099-025 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $0 | FL |
| Health First Emerald Plus H1099-026 (HMO) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $0 | FL |
| Health First Premier Access H1099-027 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $0 | FL |
| Health First Emerald Plus H1099-028 (HMO) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $0 | FL |
| Óptimo Plus (PPO) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| Contigo Plus (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| Brillante (HMO-POS) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| Enlace Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| ContigoEnMente (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| Ahorro Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| Health First Value H1099-006 (HMO) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $15.00 | FL |
| Health First Classic H1099-001 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $49.40 | FL |
Frequently Asked Questions
Is gefitinib 250 MG Oral Tablet [Iressa] covered by Medicare Part D?
Yes, gefitinib 250 MG Oral Tablet [Iressa] is covered by 22 Medicare Part D plans (0.4% of all Part D formularies).
What tier is gefitinib 250 MG Oral Tablet [Iressa] on Medicare Part D plans?
gefitinib 250 MG Oral Tablet [Iressa] averages Tier 3 across Part D plans, ranging from Tier 1 to Tier 5.
Does gefitinib 250 MG Oral Tablet [Iressa] require prior authorization?
100% of Part D formularies require prior authorization for gefitinib 250 MG Oral Tablet [Iressa]. Step therapy: 0%. Quantity limits: 25%.
How much does Medicare spend on gefitinib 250 MG Oral Tablet [Iressa]?
In 2023, total Medicare Part D spending on gefitinib 250 MG Oral Tablet [Iressa] was $3,529,858, covering 90 beneficiaries. The average spend per beneficiary was $39,220.65.
Read our methodology - how this data is sourced, computed, and verified.