Medicare Part D coverage · lemborexant · RxCUI 2272414
lemborexant 5 MG Oral Tablet [Dayvigo]
Per the CMS 2026 Part D formulary file, lemborexant 5 MG Oral Tablet [Dayvigo] is covered by 1,620 Medicare Part D plans (32.1% of enrollable products), averaging Tier 2.7, with prior authorization required on 22.4% of covering formularies.
- 32.1%
- Plan coverage
- 1,620
- Plans covering
- T2.7
- Avg tier
- 22.4%
- Prior auth required
What the CMS Formulary Data Shows for lemborexant 5 MG Oral Tablet [Dayvigo]
Per the CMS 2026 Part D formulary file, lemborexant 5 MG Oral Tablet [Dayvigo] (RxNorm concept RXCUI 2272414, generic name lemborexant) appears on 85 distinct formulary files spanning 1,620 Medicare Part D plan offerings - 32.1% 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 2.7.
Real-world access to lemborexant 5 MG Oral Tablet [Dayvigo] depends on utilization management as much as tier placement: 22.4% 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 5 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 5 MG Oral Tablet [Dayvigo] today.
Coverage Details
- Formularies covering
- 85
- Plans covering
- 1,620
- Coverage rate
- 32.1%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 22.4% 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 5 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 |
Show the next 30 plans
| 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 |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is lemborexant 5 MG Oral Tablet [Dayvigo] covered by Medicare Part D?
Yes, lemborexant 5 MG Oral Tablet [Dayvigo] is covered by 1,620 Medicare Part D plans (32.1% of all Part D formularies).
What tier is lemborexant 5 MG Oral Tablet [Dayvigo] on Medicare Part D plans?
lemborexant 5 MG Oral Tablet [Dayvigo] averages Tier 2.7 across Part D plans, ranging from Tier 1 to Tier 4.
Does lemborexant 5 MG Oral Tablet [Dayvigo] require prior authorization?
22.4% of Part D formularies require prior authorization for lemborexant 5 MG Oral Tablet [Dayvigo]. Step therapy: 1.2%. Quantity limits: 100%.
How much does Medicare spend on lemborexant 5 MG Oral Tablet [Dayvigo]?
In 2023, total Medicare Part D spending on lemborexant 5 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.
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
- 12 HR carbamazepine 200 MG Extended Release Oral Tablet T2.7
- 100 ML fluconazole 2 MG/ML Injection T2.7
- Augmented betamethasone 0.5 MG/ML Topical Lotion T2.7
- amylase 180000 UNT / lipase 36000 UNT / protease 114000 UNT Delayed Release Oral Capsule [Creon] T2.7
- 2 ML clindamycin 150 MG/ML Injection T2.7
- 0.5 ML tirzepatide 10 MG/ML Auto-Injector [Mounjaro] T2.7
Similar prior-authorization rate
- meclizine hydrochloride 12.5 MG Oral Tablet 22.4% PA
- chlorambucil 2 MG Oral Tablet [Leukeran] 22.3% PA
- methocarbamol 500 MG Oral Tablet 22.3% PA
- delafloxacin 300 MG Injection [Baxdela] 22.2% PA
- meclizine hydrochloride 25 MG Oral Tablet 22.2% PA
- 9 HR methylphenidate 1.11 MG/HR Transdermal System 22.2% PA