macitentan 10 MG / tadalafil 40 MG Oral Tablet [Opsynvi]
macitentan
RxCUI: 2677775
What the CMS Formulary Data Shows for macitentan 10 MG / tadalafil 40 MG Oral Tablet [Opsynvi]
Per the CMS 2026 Part D formulary file, macitentan 10 MG / tadalafil 40 MG Oral Tablet [Opsynvi] (RxNorm concept RXCUI 2677775, generic name macitentan) appears on 31 distinct formulary files spanning 303 Medicare Part D plan offerings - 6% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.
Real-world access to macitentan 10 MG / tadalafil 40 MG Oral Tablet [Opsynvi] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 93.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 9,031 Part D beneficiaries filled macitentan 10 MG / tadalafil 40 MG Oral Tablet [Opsynvi] in 2023, with total plan-and-beneficiary spending of $1,018,837,123 and an average per-beneficiary annual cost of $112,815.54. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry macitentan 10 MG / tadalafil 40 MG Oral Tablet [Opsynvi] today.
Coverage Details
- Formularies covering
- 31
- Plans covering
- 303
- Coverage rate
- 6%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 93.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 9,031
- Total spending
- $1,018,837,123
- Avg per beneficiary
- $112,815.54
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering macitentan 10 MG / tadalafil 40 MG Oral Tablet [Opsynvi]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| 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 |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP CARESOURCE | T1 | Yes | $0 | MI |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF FLORIDA, INC. | T1 | Yes | $4.80 | FL |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF MICHIGAN, INC. | T1 | Yes | $8.80 | MI |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF ILLINOIS, INC. | T1 | Yes | $15.20 | IL |
| WellSense Added Value (HMO) | BOSTON MEDICAL CENTER HEALTH PLAN, INC. | T1 | Yes | $21.70 | NH |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF COLORADO, INC. | T1 | Yes | $35.20 | CO |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC. | T1 | Yes | $36.20 | NC |
| Longevity Health Plan (PPO I-SNP) | LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP | T1 | Yes | $40.00 | NJ |
| ElderServe Star (HMO I-SNP) | ELDERSERVE HEALTH, INC. | T1 | Yes | $58.80 | NY |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF NEW YORK, INC. | T1 | Yes | $58.80 | NY |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| Community Blue Medicare HMO Signature (HMO) | Highmark Western and Northeastern New York Inc. | T5 | Yes | $0 | NY |
| Community Blue Medicare HMO Merit (HMO) | Highmark Western and Northeastern New York Inc. | T5 | Yes | $0 | NY |
| Community Blue Medicare PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Merit (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Distinct (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue Plus PPO Merit (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Merit (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare HMO Signature (HMO) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Security Blue HMO-POS ValueRx (HMO-POS) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare HMO Signature (HMO) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Together Blue Medicare HMO Signature (HMO) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare HMO Distinct (HMO) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Complete Blue HMO Distinct (HMO) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Distinct (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T5 | Yes | $0 | WV |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T5 | Yes | $0 | WV |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T5 | Yes | $0 | WV |
| Complete Blue PPO Merit (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T5 | Yes | $0 | WV |
| Complete Blue PPO Signature (PPO) | HIGHMARK BCBSD INC. | T5 | Yes | $0 | DE |
| Medicare BlueEssential (PPO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| Medicare BlueActive (PPO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| Medicare BlueVital (PPO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| Univera SeniorChoice Basic (HMO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| Univera SeniorChoice Extra (HMO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| Medicare Blue Choice Core (HMO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| The Health Plan SecureCare - Option II (HMO) | THE HEALTH PLAN OF WEST VIRGINIA, INC. | T5 | Yes | $0 | OH |
| The Health Plan SecureCare - Option II (HMO) | THE HEALTH PLAN OF WEST VIRGINIA, INC. | T5 | Yes | $0 | OH, WV |
| The Health Plan SecureCare Capitol Plan (HMO) | THE HEALTH PLAN OF WEST VIRGINIA, INC. | T5 | Yes | $0 | WV |
| The Health Plan SecureChoice Optimum (PPO) | THP INSURANCE COMPANY | T5 | Yes | $0 | OH, WV |
Frequently Asked Questions
Is macitentan 10 MG / tadalafil 40 MG Oral Tablet [Opsynvi] covered by Medicare Part D?
Yes, macitentan 10 MG / tadalafil 40 MG Oral Tablet [Opsynvi] is covered by 303 Medicare Part D plans (6% of all Part D formularies).
What tier is macitentan 10 MG / tadalafil 40 MG Oral Tablet [Opsynvi] on Medicare Part D plans?
macitentan 10 MG / tadalafil 40 MG Oral Tablet [Opsynvi] averages Tier 4 across Part D plans, ranging from Tier 1 to Tier 5.
Does macitentan 10 MG / tadalafil 40 MG Oral Tablet [Opsynvi] require prior authorization?
100% of Part D formularies require prior authorization for macitentan 10 MG / tadalafil 40 MG Oral Tablet [Opsynvi]. Step therapy: 0%. Quantity limits: 93.5%.
How much does Medicare spend on macitentan 10 MG / tadalafil 40 MG Oral Tablet [Opsynvi]?
In 2023, total Medicare Part D spending on macitentan 10 MG / tadalafil 40 MG Oral Tablet [Opsynvi] was $1,018,837,123, covering 9,031 beneficiaries. The average spend per beneficiary was $112,815.54.
Read our methodology - how this data is sourced, computed, and verified.