lomitapide 20 MG Oral Capsule [Juxtapid]
lomitapide
RxCUI: 1364494
What the CMS Formulary Data Shows for lomitapide 20 MG Oral Capsule [Juxtapid]
Per the CMS 2026 Part D formulary file, lomitapide 20 MG Oral Capsule [Juxtapid] (RxNorm concept RXCUI 1364494, generic name lomitapide) appears on 41 distinct formulary files spanning 179 Medicare Part D plan offerings - 3.5% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 4.2.
Real-world access to lomitapide 20 MG Oral Capsule [Juxtapid] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 58.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 14 Part D beneficiaries filled lomitapide 20 MG Oral Capsule [Juxtapid] in 2023, with total plan-and-beneficiary spending of $8,683,000 and an average per-beneficiary annual cost of $620,214.27. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry lomitapide 20 MG Oral Capsule [Juxtapid] today.
Coverage Details
- Formularies covering
- 41
- Plans covering
- 179
- Coverage rate
- 3.5%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 58.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 14
- Total spending
- $8,683,000
- Avg per beneficiary
- $620,214.27
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering lomitapide 20 MG Oral Capsule [Juxtapid]
100 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 |
| Community Care's Partnership Program (HMO D-SNP) | COMMUNITY CARE HEALTH PLAN, INC. | T1 | Yes | $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 |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T1 | Yes | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T1 | Yes | $17.00 | AZ |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $34.50 | NY |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| Freedom VIP Care (HMO C-SNP) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T4 | Yes | $0 | FL |
| Optimum Diamond Savings (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T4 | Yes | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T4 | Yes | $0 | FL |
| Optimum Diamond (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T4 | Yes | $0 | FL |
| Freedom Medi-Medi Partial (HMO D-SNP) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom Medi-Medi Full (HMO D-SNP) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Optimum Emerald Partial (HMO D-SNP) | OPTIMUM HEALTHCARE, INC. | T4 | Yes | $0 | FL |
| Optimum Emerald Full (HMO D-SNP) | OPTIMUM HEALTHCARE, INC. | T4 | Yes | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom Máximo (HMO-POS) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Freedom Máximo (HMO-POS) | FREEDOM HEALTH, INC. | T4 | Yes | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T4 | Yes | $0 | FL |
| Optimum Platinum Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T4 | Yes | $0 | FL |
| Optimum Gold Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T4 | Yes | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T4 | Yes | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T4 | Yes | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T4 | Yes | $0 | FL |
| Optimum Diamond Savings COPD (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T4 | Yes | $0 | FL |
| Optimum Gold Plus Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T4 | Yes | $0 | FL |
Frequently Asked Questions
Is lomitapide 20 MG Oral Capsule [Juxtapid] covered by Medicare Part D?
Yes, lomitapide 20 MG Oral Capsule [Juxtapid] is covered by 179 Medicare Part D plans (3.5% of all Part D formularies).
What tier is lomitapide 20 MG Oral Capsule [Juxtapid] on Medicare Part D plans?
lomitapide 20 MG Oral Capsule [Juxtapid] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 6.
Does lomitapide 20 MG Oral Capsule [Juxtapid] require prior authorization?
100% of Part D formularies require prior authorization for lomitapide 20 MG Oral Capsule [Juxtapid]. Step therapy: 0%. Quantity limits: 58.5%.
How much does Medicare spend on lomitapide 20 MG Oral Capsule [Juxtapid]?
In 2023, total Medicare Part D spending on lomitapide 20 MG Oral Capsule [Juxtapid] was $8,683,000, covering 14 beneficiaries. The average spend per beneficiary was $620,214.27.
Read our methodology - how this data is sourced, computed, and verified.