lemborexant 10 MG Oral Tablet [Dayvigo]
lemborexant
RxCUI: 2288427
What the CMS Formulary Data Shows for lemborexant 10 MG Oral Tablet [Dayvigo]
Per the CMS 2026 Part D formulary file, lemborexant 10 MG Oral Tablet [Dayvigo] (RxNorm concept RXCUI 2288427, generic name lemborexant) appears on 81 distinct formulary files spanning 1,435 Medicare Part D plan offerings - 28.3% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.6.
Real-world access to lemborexant 10 MG Oral Tablet [Dayvigo] depends on utilization management as much as tier placement: 23.5% of covering formularies require prior authorization. 1.2% require step therapy. 100% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 11,530 Part D beneficiaries filled lemborexant 10 MG Oral Tablet [Dayvigo] in 2023, with total plan-and-beneficiary spending of $16,516,063 and an average per-beneficiary annual cost of $1,432.44. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry lemborexant 10 MG Oral Tablet [Dayvigo] today.
Coverage Details
- Formularies covering
- 81
- Plans covering
- 1,435
- Coverage rate
- 28.3%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 23.5% of formularies
- Step therapy required
- 1.2% of formularies
- Quantity limits
- 100% of formularies
2023 Medicare Spending
- Beneficiaries
- 11,530
- Total spending
- $16,516,063
- Avg per beneficiary
- $1,432.44
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering lemborexant 10 MG Oral Tablet [Dayvigo]
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 | No | $0 | FL |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | ELDERPLAN, INC. | T1 | No | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | HEALTH CHOICE ARIZONA, INC. | T1 | No | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | HEALTHFIRST HEALTH PLAN, INC. | T1 | No | $0 | NY |
| IMCare Classic (HMO D-SNP) | ITASCA MEDICAL CARE | T1 | No | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | HOPKINS HEALTH ADVANTAGE, INC. | T1 | No | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | METROPLUS HEALTH PLAN, INC. | T1 | No | $0 | NY |
| Senior Whole Health SCO (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| Molina One Care (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| 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 |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $0 | NY |
| CCA One Care (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | T1 | No | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | T1 | No | $0 | MA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK HEALTH OPTIONS WEST VIRGINIA INC. | T1 | No | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | No | $0 | DE |
| Florida Complete Care (HMO I-SNP) | HPMP OF FLORIDA, INC. | T1 | No | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | HPMP OF FLORIDA, INC. | T1 | No | $4.80 | FL |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | HCSC INSURANCE SERVICES COMPANY | T1 | Yes | $4.80 | TX |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS INSURANCE COMPANY | T1 | Yes | $5.00 | OK |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $13.10 | PA |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $17.60 | PA |
| Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) | ELDERPLAN, INC. | T1 | No | $22.70 | NY |
| VIVA Medicare Extra Value (HMO D-SNP) | VIVA HEALTH, INC. | T1 | No | $27.70 | AL |
| VIVA Medicare Extra Care (HMO D-SNP) | VIVA HEALTH, INC. | T1 | No | $27.70 | AL |
| Highmark Health Options Duals Select (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | No | $31.20 | DE |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $34.50 | NY |
| Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) | ELDERPLAN, INC. | T1 | No | $44.80 | NY |
| MetroPlus Platinum Plan (HMO) | METROPLUS HEALTH PLAN, INC. | T1 | No | $58.80 | NY |
| Aetna Medicare Signature (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T3 | No | $0 | CA |
| Aetna Medicare Signature (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T3 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T3 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T3 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T3 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T3 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T3 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T3 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T3 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T3 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T3 | No | $0 | CA |
| Aetna Medicare Signature Care (HMO-POS) | AETNA HEALTH OF OHIO INC. | T3 | No | $0 | OH |
| Aetna Medicare Signature Extra (HMO-POS) | AETNA HEALTH OF OHIO INC. | T3 | No | $0 | OH |
Frequently Asked Questions
Is lemborexant 10 MG Oral Tablet [Dayvigo] covered by Medicare Part D?
Yes, lemborexant 10 MG Oral Tablet [Dayvigo] is covered by 1,435 Medicare Part D plans (28.3% of all Part D formularies).
What tier is lemborexant 10 MG Oral Tablet [Dayvigo] on Medicare Part D plans?
lemborexant 10 MG Oral Tablet [Dayvigo] averages Tier 2.6 across Part D plans, ranging from Tier 1 to Tier 4.
Does lemborexant 10 MG Oral Tablet [Dayvigo] require prior authorization?
23.5% of Part D formularies require prior authorization for lemborexant 10 MG Oral Tablet [Dayvigo]. Step therapy: 1.2%. Quantity limits: 100%.
How much does Medicare spend on lemborexant 10 MG Oral Tablet [Dayvigo]?
In 2023, total Medicare Part D spending on lemborexant 10 MG Oral Tablet [Dayvigo] was $16,516,063, covering 11,530 beneficiaries. The average spend per beneficiary was $1,432.44.
Read our methodology - how this data is sourced, computed, and verified.