mavorixafor 100 MG Oral Capsule [Xolremdi]
mavorixafor
RxCUI: 2684032
Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.
20.6%
Plan Coverage
1,046
Plans Covering
T4.5
Avg Tier
100%
Prior Auth Required
What the CMS Formulary Data Shows for mavorixafor 100 MG Oral Capsule [Xolremdi]
Per the CMS 2026 Part D formulary file, mavorixafor 100 MG Oral Capsule [Xolremdi] (RxNorm concept RXCUI 2684032, generic name mavorixafor) appears on 50 distinct formulary files spanning 1,046 Medicare Part D plan offerings - 20.6% 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 4.5.
Real-world access to mavorixafor 100 MG Oral Capsule [Xolremdi] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 78% apply quantity limits.
Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry mavorixafor 100 MG Oral Capsule [Xolremdi] today.
Coverage Details
- Formularies covering
- 50
- Plans covering
- 1,046
- Coverage rate
- 20.6%
- 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
- 78% of formularies
Tier Distribution Across Plans
30 plans
Tier 1, Preferred Generic
1 plans
Tier 2, Generic
69 plans
Tier 5, Specialty
Standalone Drug Plans (PDP) Covering mavorixafor 100 MG Oral Capsule [Xolremdi]
5 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T5 | Yes | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering mavorixafor 100 MG Oral Capsule [Xolremdi]
95 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | Yes | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | Yes | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | Yes | $0 | IN |
| Provider Partners Maryland Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | Yes | $0 | MD |
| Provider Partners Missouri Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | Yes | $0 | MO |
| 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 |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | Yes | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | Yes | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK HEALTH OPTIONS WEST VIRGINIA INC. | T1 | Yes | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | Yes | $0 | DE |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC. | T1 | Yes | $4.80 | TX |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | Yes | $13.10 | PA |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS | T1 | Yes | $15.20 | IL |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | Yes | $17.60 | PA |
| Provider Partners Maryland Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | Yes | $31.20 | MD |
| Provider Partners Maryland Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | Yes | $31.20 | MD |
| Highmark Health Options Duals Select (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | Yes | $31.20 | DE |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | Yes | $32.70 | PA |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | Yes | $32.70 | PA |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | Yes | $36.20 | NC |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | Yes | $36.20 | NC |
| Provider Partners Indiana Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | Yes | $38.40 | IN |
| Provider Partners Indiana Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | Yes | $38.40 | IN |
| Provider Partners Kentucky Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF KENTUCKY | T1 | Yes | $38.40 | KY |
| Provider Partners Missouri Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | Yes | $43.00 | MO |
| Provider Partners Missouri Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | Yes | $43.00 | MO |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| UHC Dual Complete IA-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T5 | Yes | $0 | IA |
| UHC Dual Complete MO-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T5 | Yes | $0 | MO |
| UHC Dual Complete NE-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T5 | Yes | $0 | NE |
| UHC Dual Complete KS-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T5 | Yes | $0 | KS |
| UHC Dual Complete MO-S3 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T5 | Yes | $0 | MO |
| UHC Dual Complete KS-Q1 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T5 | Yes | $0 | KS |
| UHC Dual Complete TN-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T5 | Yes | $0 | TN |
| UHC Dual Complete TN-Y001 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T5 | Yes | $0 | TN |
| UHC Dual Complete TN-Y2 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T5 | Yes | $0 | TN |
| AARP Medicare Advantage from UHC MI-0001 (PPO) | UNITEDHEALTHCARE INSURANCE COMPANY | T5 | Yes | $0 | MI |
| UHC Dual Complete NM-Y1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T5 | Yes | $0 | NM |
| UHC Dual Complete NM-S1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T5 | Yes | $0 | NM |
| UHC Dual Complete NM-V1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T5 | Yes | $0 | NM |
| UHC Dual Complete AZ-S001 (HMO-POS D-SNP) | ARIZONA PHYSICIANS IPA, INC. | T5 | Yes | $0 | AZ |
| UHC Dual Complete AZ-Y001 (HMO-POS D-SNP) | ARIZONA PHYSICIANS IPA, INC. | T5 | Yes | $0 | AZ |
| UHC Dual Complete VA-Y4 (PPO D-SNP) | CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO. | T5 | Yes | $0 | VA |
| AARP Medicare Advantage from UHC AL-0001 (HMO-POS) | UNITEDHEALTHCARE OF THE MIDLANDS, INC. | T5 | Yes | $0 | AL |
| AARP Medicare Advantage from UHC CA-0002 (HMO-POS) | UHC OF CALIFORNIA | T5 | Yes | $0 | CA |
| UHC Sharp Medicare Advantage CA-001P (HMO-POS) | UHC OF CALIFORNIA | T5 | Yes | $0 | CA |
Frequently Asked Questions
Is mavorixafor 100 MG Oral Capsule [Xolremdi] covered by Medicare Part D?
Yes, mavorixafor 100 MG Oral Capsule [Xolremdi] is covered by 1,046 Medicare Part D plans (20.6% of all Part D formularies).
What tier is mavorixafor 100 MG Oral Capsule [Xolremdi] on Medicare Part D plans?
mavorixafor 100 MG Oral Capsule [Xolremdi] averages Tier 4.5 across Part D plans, ranging from Tier 1 to Tier 6.
Does mavorixafor 100 MG Oral Capsule [Xolremdi] require prior authorization?
100% of Part D formularies require prior authorization for mavorixafor 100 MG Oral Capsule [Xolremdi]. Step therapy: 0%. Quantity limits: 78%.
Read our methodology - how this data is sourced, computed, and verified.
Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare Editorial