Medicare Part D coverage · ivacaftor · RxCUI 2611460
ivacaftor 94 MG / lumacaftor 75 MG Oral Granules [ORKAMBI]
Per the CMS 2026 Part D formulary file, ivacaftor 94 MG / lumacaftor 75 MG Oral Granules [ORKAMBI] is covered by 3,441 Medicare Part D plans (68.1% of enrollable products), averaging Tier 4.2, with prior authorization required on 99.2% of covering formularies.
- 68.1%
- Plan coverage
- 3,441
- Plans covering
- T4.2
- Avg tier
- 99.2%
- Prior auth required
What the CMS Formulary Data Shows for ivacaftor 94 MG / lumacaftor 75 MG Oral Granules [ORKAMBI]
Per the CMS 2026 Part D formulary file, ivacaftor 94 MG / lumacaftor 75 MG Oral Granules [ORKAMBI] (RxNorm concept RXCUI 2611460, generic name ivacaftor) appears on 241 distinct formulary files spanning 3,441 Medicare Part D plan offerings - 68.1% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 4.2.
Real-world access to ivacaftor 94 MG / lumacaftor 75 MG Oral Granules [ORKAMBI] depends on utilization management as much as tier placement: 99.2% of covering formularies require prior authorization. 0% require step therapy. 94.2% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 91 Part D beneficiaries filled ivacaftor 94 MG / lumacaftor 75 MG Oral Granules [ORKAMBI] in 2023, with total plan-and-beneficiary spending of $25,099,036 and an average per-beneficiary annual cost of $275,813.58. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry ivacaftor 94 MG / lumacaftor 75 MG Oral Granules [ORKAMBI] today.
Coverage Details
- Formularies covering
- 241
- Plans covering
- 3,441
- Coverage rate
- 68.1%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 99.2% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 94.2% of formularies
2023 Medicare Spending
- Beneficiaries
- 91
- Total spending
- $25,099,036
- Avg per beneficiary
- $275,813.58
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering ivacaftor 94 MG / lumacaftor 75 MG Oral Granules [ORKAMBI]
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 |
| 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 | 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 |
| 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 | 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 |
| 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 |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | Yes | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $0 | DE |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | Yes | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | Yes | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | Yes | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | Yes | $0 | MA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is ivacaftor 94 MG / lumacaftor 75 MG Oral Granules [ORKAMBI] covered by Medicare Part D?
Yes, ivacaftor 94 MG / lumacaftor 75 MG Oral Granules [ORKAMBI] is covered by 3,441 Medicare Part D plans (68.1% of all Part D formularies).
What tier is ivacaftor 94 MG / lumacaftor 75 MG Oral Granules [ORKAMBI] on Medicare Part D plans?
ivacaftor 94 MG / lumacaftor 75 MG Oral Granules [ORKAMBI] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 6.
Does ivacaftor 94 MG / lumacaftor 75 MG Oral Granules [ORKAMBI] require prior authorization?
99.2% of Part D formularies require prior authorization for ivacaftor 94 MG / lumacaftor 75 MG Oral Granules [ORKAMBI]. Step therapy: 0%. Quantity limits: 94.2%.
How much does Medicare spend on ivacaftor 94 MG / lumacaftor 75 MG Oral Granules [ORKAMBI]?
In 2023, total Medicare Part D spending on ivacaftor 94 MG / lumacaftor 75 MG Oral Granules [ORKAMBI] was $25,099,036, covering 91 beneficiaries. The average spend per beneficiary was $275,813.58.
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
- dasatinib 20 MG Oral Tablet T4.2
- rilpivirine 2.5 MG Tablet for Oral Suspension [Edurant] T4.2
- tenofovir disoproxil fumarate 250 MG Oral Tablet [Viread] T4.2
- sodium oxybate 500 MG/ML Oral Solution T4.2
- sapropterin dihydrochloride 100 MG Oral Tablet T4.2
- {4 (apremilast 10 MG Oral Tablet [Otezla]) / 4 (apremilast 20 MG Oral Tablet [Otezla]) / 47 (apremilast 30 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20/30 Starter Pack] T4.2
Similar prior-authorization rate
- levalbuterol 0.103 MG/ML Inhalation Solution 99.2% PA
- levalbuterol 2.5 MG/ML Inhalation Solution 99.2% PA
- epoetin alfa-epbx 10000 UNT/ML Injectable Solution [Retacrit] 99.2% PA
- 1 ML epoetin alfa-epbx 10000 UNT/ML Injection [Retacrit] 99.2% PA
- 1 ML epoetin alfa-epbx 40000 UNT/ML Injection [Retacrit] 99.2% PA
- eltrombopag 18 MG Oral Tablet [Alvaiz] 99.2% PA