mavacamten 2.5 MG Oral Capsule [Camzyos]
mavacamten
RxCUI: 2600886
What the CMS Formulary Data Shows for mavacamten 2.5 MG Oral Capsule [Camzyos]
Per the CMS 2026 Part D formulary file, mavacamten 2.5 MG Oral Capsule [Camzyos] (RxNorm concept RXCUI 2600886, generic name mavacamten) appears on 101 distinct formulary files spanning 527 Medicare Part D plan offerings - 10.4% 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.
Real-world access to mavacamten 2.5 MG Oral Capsule [Camzyos] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 100% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 2,006 Part D beneficiaries filled mavacamten 2.5 MG Oral Capsule [Camzyos] in 2023, with total plan-and-beneficiary spending of $105,090,144 and an average per-beneficiary annual cost of $52,387.91. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry mavacamten 2.5 MG Oral Capsule [Camzyos] today.
Coverage Details
- Formularies covering
- 101
- Plans covering
- 527
- Coverage rate
- 10.4%
- 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
- 100% of formularies
2023 Medicare Spending
- Beneficiaries
- 2,006
- Total spending
- $105,090,144
- Avg per beneficiary
- $52,387.91
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering mavacamten 2.5 MG Oral Capsule [Camzyos]
9 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T5 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T5 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T5 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T5 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T5 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T5 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T5 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T5 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T5 | Yes | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering mavacamten 2.5 MG Oral Capsule [Camzyos]
91 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 |
| SeniorCare Complete (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | ALAMEDA ALLIANCE FOR HEALTH | T1 | Yes | $0 | CA |
| Elevate Medicare Choice (HMO D-SNP) | DENVER HEALTH MEDICAL PLAN, INC. | T1 | Yes | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | ALLCARE HEALTH PLAN, INC. | T1 | Yes | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE | T1 | Yes | $0 | MN |
| Prime Health Complete (HMO D-SNP) | PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE | T1 | Yes | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | ALTERWOOD ADVANTAGE, INC. | T1 | Yes | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK | T1 | Yes | $0 | NY |
| Abilis Health Community (HMO I-SNP) | SIGNATURE ADVANTAGE, LLC | T1 | Yes | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | ARKANSAS SUPERIOR SELECT, INC. | T1 | Yes | $0 | AR |
| 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 |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF FLORIDA, INC. | T1 | Yes | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T1 | Yes | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | TEXAS INDEPENDENCE HEALTH PLAN, INC. | T1 | Yes | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | TEXAS INDEPENDENCE HEALTH PLAN, INC. | T1 | Yes | $4.80 | TX |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF MICHIGAN, INC. | T1 | Yes | $8.80 | MI |
| Tribute Select (HMO-POS I-SNP) | ARKANSAS SUPERIOR SELECT, INC. | T1 | Yes | $8.90 | AR |
| ATRIO Special Needs Plan (HMO D-SNP) | ATRIO HEALTH PLANS | T1 | Yes | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | ATRIO HEALTH PLANS | T1 | Yes | $10.50 | OR |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF ILLINOIS, INC. | T1 | Yes | $15.20 | IL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T1 | Yes | $17.00 | AZ |
| WellSense Added Value (HMO) | BOSTON MEDICAL CENTER HEALTH PLAN, INC. | T1 | Yes | $21.70 | NH |
| Alterwood Advantage Dual Value (HMO D-SNP) | ALTERWOOD ADVANTAGE, INC. | T1 | Yes | $31.20 | MD |
| Valor Health Plan (HMO I-SNP) | TSG GUARD, INC. | T1 | Yes | $31.40 | OH |
| WV Senior Advantage (HMO I-SNP) | WEST VIRGINIA SENIOR ADVANTAGE, INC. | T1 | Yes | $32.70 | WV |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF COLORADO, INC. | T1 | Yes | $35.20 | CO |
| Abilis Health (HMO I-SNP) | SIGNATURE ADVANTAGE, LLC | T1 | Yes | $35.90 | KY, TN |
| Longevity Health Plan (HMO I-SNP) | LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC. | T1 | Yes | $36.20 | NC |
| CommuniCare Advantage ISNP (HMO I-SNP) | OH CHS SNP INC. | T1 | Yes | $38.40 | IN, MD, OH |
| 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 |
| Nascentia Skilled Nursing Facility (HMO I-SNP) | VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK | T1 | Yes | $58.80 | NY |
| CareAdvantage (HMO D-SNP) | SAN MATEO HEALTH COMMISSION | T2 | Yes | $0 | CA |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| HAP Medicare Explore (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T4 | Yes | $0 | MI |
| HAP Medicare Prime (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T4 | Yes | $0 | MI |
| HAP Medicare Connect (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T4 | Yes | $0 | MI |
| HAP Medicare Complete Duals (HMO D-SNP) | HEALTH ALLIANCE PLAN OF MICHIGAN | T4 | Yes | $0 | MI |
| HAP Medicare Superior (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T4 | Yes | $0 | MI |
| Henry Ford Select (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T4 | Yes | $0 | MI |
| PHP (HMO C-SNP) | AIDS HEALTHCARE FOUNDATION | T4 | Yes | $0 | CA |
Frequently Asked Questions
Is mavacamten 2.5 MG Oral Capsule [Camzyos] covered by Medicare Part D?
Yes, mavacamten 2.5 MG Oral Capsule [Camzyos] is covered by 527 Medicare Part D plans (10.4% of all Part D formularies).
What tier is mavacamten 2.5 MG Oral Capsule [Camzyos] on Medicare Part D plans?
mavacamten 2.5 MG Oral Capsule [Camzyos] averages Tier 4 across Part D plans, ranging from Tier 1 to Tier 6.
Does mavacamten 2.5 MG Oral Capsule [Camzyos] require prior authorization?
100% of Part D formularies require prior authorization for mavacamten 2.5 MG Oral Capsule [Camzyos]. Step therapy: 0%. Quantity limits: 100%.
How much does Medicare spend on mavacamten 2.5 MG Oral Capsule [Camzyos]?
In 2023, total Medicare Part D spending on mavacamten 2.5 MG Oral Capsule [Camzyos] was $105,090,144, covering 2,006 beneficiaries. The average spend per beneficiary was $52,387.91.
Read our methodology - how this data is sourced, computed, and verified.