Medicare Part D coverage · loxapine · RxCUI 314075
loxapine 50 MG Oral Capsule
Per the CMS 2026 Part D formulary file, loxapine 50 MG Oral Capsule is covered by 5,052 Medicare Part D plans (100% of enrollable products), averaging Tier 2.2, with prior authorization required on 13.7% of covering formularies.
- 100%
- Plan coverage
- 5,052
- Plans covering
- T2.2
- Avg tier
- 13.7%
- Prior auth required
What the CMS Formulary Data Shows for loxapine 50 MG Oral Capsule
Per the CMS 2026 Part D formulary file, loxapine 50 MG Oral Capsule (RxNorm concept RXCUI 314075, generic name loxapine) 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 4, with a cross-plan average of Tier 2.2.
Real-world access to loxapine 50 MG Oral Capsule depends on utilization management as much as tier placement: 13.7% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 8,065 Part D beneficiaries filled loxapine 50 MG Oral Capsule in 2023, with total plan-and-beneficiary spending of $4,133,427 and an average per-beneficiary annual cost of $512.51. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry loxapine 50 MG Oral Capsule today.
Coverage Details
- Formularies covering
- 328
- Plans covering
- 5,052
- Coverage rate
- 100%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 13.7% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 8,065
- Total spending
- $4,133,427
- Avg per beneficiary
- $512.51
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering loxapine 50 MG Oral Capsule
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 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T1 | No | $0 | FL |
| HealthSun MediMax (HMO) | Healthsun Health Plans, Inc. | T1 | No | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T1 | No | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T1 | No | $0 | FL |
| HealthSun MediSun Plus (HMO D-SNP) | Healthsun Health Plans, Inc. | T1 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T1 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T1 | No | $0 | FL |
| HealthSun MediSun Extra (HMO D-SNP) | Healthsun Health Plans, Inc. | T1 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T1 | No | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | Healthsun Health Plans, Inc. | T1 | No | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | Healthsun Health Plans, Inc. | T1 | No | $0 | FL |
| HealthSun MediSun Full Dual Plus (HMO D-SNP) | Healthsun Health Plans, Inc. | T1 | No | $0 | FL |
| HealthSun MediSun Full Dual Extra (HMO D-SNP) | Healthsun Health Plans, Inc. | T1 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
Show the next 30 plans
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Extra (HMO) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Extra Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply More Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Complete Platinum (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Extra Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Extra Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Extra Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply More Platinum (HMO) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Complete Platinum (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
| Simply Integrated (HMO D-SNP) | Simply Healthcare Plans, Inc. | T1 | No | $0 | FL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is loxapine 50 MG Oral Capsule covered by Medicare Part D?
Yes, loxapine 50 MG Oral Capsule is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).
What tier is loxapine 50 MG Oral Capsule on Medicare Part D plans?
loxapine 50 MG Oral Capsule averages Tier 2.2 across Part D plans, ranging from Tier 1 to Tier 4.
Does loxapine 50 MG Oral Capsule require prior authorization?
13.7% of Part D formularies require prior authorization for loxapine 50 MG Oral Capsule. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on loxapine 50 MG Oral Capsule?
In 2023, total Medicare Part D spending on loxapine 50 MG Oral Capsule was $4,133,427, covering 8,065 beneficiaries. The average spend per beneficiary was $512.51.
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
- oseltamivir 75 MG Oral Capsule T2.2
- {21 (desogestrel 0.15 MG / ethinyl estradiol 0.02 MG Oral Tablet) / 5 (ethinyl estradiol 0.01 MG Oral Tablet) / 2 (inert ingredients 1 MG Oral Tablet) } Pack [Kariva 28 Day] T2.2
- cefadroxil 50 MG/ML Oral Suspension T2.2
- {21 (desogestrel 0.15 MG / ethinyl estradiol 0.02 MG Oral Tablet) / 5 (ethinyl estradiol 0.01 MG Oral Tablet) / 2 (inert ingredients 1 MG Oral Tablet) } Pack [Azurette 28 Day] T2.2
- {21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } Pack [Larin 1.5/30] T2.2
- {21 (desogestrel 0.15 MG / ethinyl estradiol 0.02 MG Oral Tablet) / 5 (ethinyl estradiol 0.01 MG Oral Tablet) / 2 (inert ingredients 1 MG Oral Tablet) } Pack [Viorele 28 Day] T2.2
Similar prior-authorization rate
- risperidone 3 MG Disintegrating Oral Tablet 13.7% PA
- risperidone 2 MG Disintegrating Oral Tablet 13.7% PA
- risperidone 1 MG Disintegrating Oral Tablet 13.7% PA
- risperidone 0.5 MG Disintegrating Oral Tablet 13.7% PA
- danazol 100 MG Oral Capsule 13.7% PA
- fluphenazine hydrochloride 0.5 MG/ML Oral Solution 13.7% PA