Medicare Part D coverage · iloperidone · RxCUI 848746
iloperidone 6 MG Oral Tablet [Fanapt]
Per the CMS 2026 Part D formulary file, iloperidone 6 MG Oral Tablet [Fanapt] is covered by 5,052 Medicare Part D plans (100% of enrollable products), averaging Tier 4.1, with prior authorization required on 60.7% of covering formularies.
- 100%
- Plan coverage
- 5,052
- Plans covering
- T4.1
- Avg tier
- 60.7%
- Prior auth required
What the CMS Formulary Data Shows for iloperidone 6 MG Oral Tablet [Fanapt]
Per the CMS 2026 Part D formulary file, iloperidone 6 MG Oral Tablet [Fanapt] (RxNorm concept RXCUI 848746, generic name iloperidone) appears on 328 distinct formulary files spanning 5,052 Medicare Part D plan offerings - 100% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 4.1.
Real-world access to iloperidone 6 MG Oral Tablet [Fanapt] depends on utilization management as much as tier placement: 60.7% of covering formularies require prior authorization. 37.2% require step therapy. 96% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 4,164 Part D beneficiaries filled iloperidone 6 MG Oral Tablet [Fanapt] in 2023, with total plan-and-beneficiary spending of $92,779,041 and an average per-beneficiary annual cost of $22,281.23. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry iloperidone 6 MG Oral Tablet [Fanapt] today.
Coverage Details
- Formularies covering
- 328
- Plans covering
- 5,052
- Coverage rate
- 100%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 60.7% of formularies
- Step therapy required
- 37.2% of formularies
- Quantity limits
- 96% of formularies
2023 Medicare Spending
- Beneficiaries
- 4,164
- Total spending
- $92,779,041
- Avg per beneficiary
- $22,281.23
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering iloperidone 6 MG Oral Tablet [Fanapt]
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 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $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 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | No | $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 | No | $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 |
| 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 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| 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 |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | No | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | No | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | No | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | No | $0 | NY |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $0 | MO |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | No | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | No | $0 | AR |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is iloperidone 6 MG Oral Tablet [Fanapt] covered by Medicare Part D?
Yes, iloperidone 6 MG Oral Tablet [Fanapt] is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).
What tier is iloperidone 6 MG Oral Tablet [Fanapt] on Medicare Part D plans?
iloperidone 6 MG Oral Tablet [Fanapt] averages Tier 4.1 across Part D plans, ranging from Tier 1 to Tier 6.
Does iloperidone 6 MG Oral Tablet [Fanapt] require prior authorization?
60.7% of Part D formularies require prior authorization for iloperidone 6 MG Oral Tablet [Fanapt]. Step therapy: 37.2%. Quantity limits: 96%.
How much does Medicare spend on iloperidone 6 MG Oral Tablet [Fanapt]?
In 2023, total Medicare Part D spending on iloperidone 6 MG Oral Tablet [Fanapt] was $92,779,041, covering 4,164 beneficiaries. The average spend per beneficiary was $22,281.23.
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
- {52 (trospium chloride 20 MG / xanomeline 100 MG Oral Capsule [Cobenfy]) / 4 (trospium chloride 20 MG / xanomeline 50 MG Oral Capsule [Cobenfy]) } Pack [Cobenfy 28-Day Starter Kit] T4.1
- flutamide 125 MG Oral Capsule [Eulexin] T4.1
- lumateperone 42 MG Oral Capsule [Caplyta] T4.1
- trospium chloride 30 MG / xanomeline 125 MG Oral Capsule [Cobenfy] T4.1
- avatrombopag 10 MG Oral Granules [Doptelet] T4.1
- 1 ML ustekinumab-stba 90 MG/ML Prefilled Syringe [Steqeyma] T4.1
Similar prior-authorization rate
- cyproheptadine hydrochloride 0.4 MG/ML Oral Solution 60.7% PA
- aspirin 325 MG / butalbital 50 MG / caffeine 40 MG / codeine phosphate 30 MG Oral Capsule 60.7% PA
- {2 (iloperidone 1 MG Oral Tablet [Fanapt]) / 2 (iloperidone 2 MG Oral Tablet [Fanapt]) / 2 (iloperidone 4 MG Oral Tablet [Fanapt]) / 2 (iloperidone 6 MG Oral Tablet [Fanapt]) } Pack [Fanapt Titration Pack] 60.7% PA
- 24 HR budesonide 9 MG Extended Release Oral Tablet 60.7% PA
- ivermectin 6 MG Oral Tablet 60.2% PA
- acetaminophen 325 MG / butalbital 50 MG / caffeine 40 MG / codeine phosphate 30 MG Oral Capsule 61.3% PA