metaxalone 400 MG Oral Tablet
metaxalone
RxCUI: 197935
What the CMS Formulary Data Shows for metaxalone 400 MG Oral Tablet
Per the CMS 2026 Part D formulary file, metaxalone 400 MG Oral Tablet (RxNorm concept RXCUI 197935, generic name metaxalone) appears on 4 distinct formulary files spanning 29 Medicare Part D plan offerings - 0.6% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 2 to Tier 4, with a cross-plan average of Tier 3.
Real-world access to metaxalone 400 MG Oral Tablet depends on utilization management as much as tier placement: 50% of covering formularies require prior authorization. 25% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 24,167 Part D beneficiaries filled metaxalone 400 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $9,747,346 and an average per-beneficiary annual cost of $403.33. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry metaxalone 400 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 4
- Plans covering
- 29
- Coverage rate
- 0.6%
- Tier range
- Tier 2 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 50% of formularies
- Step therapy required
- 25% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 24,167
- Total spending
- $9,747,346
- Avg per beneficiary
- $403.33
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering metaxalone 400 MG Oral Tablet
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP) | HM HEALTH INSURANCE COMPANY | T2 | Yes | No | $164.80 | - |
| Blue Rx PDP Plus (PDP) | HM HEALTH INSURANCE COMPANY | T2 | Yes | No | $193.20 | - |
Medicare Advantage Plans (MA-PD) Covering metaxalone 400 MG Oral Tablet
27 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| MCS Classicare RxMax (HMO) | MCS ADVANTAGE, INC. | T2 | No | $0 | PR |
| Security Blue HMO-POS Standard (HMO-POS) | HIGHMARK CHOICE COMPANY | T2 | Yes | $51.80 | PA |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T2 | Yes | $95.70 | PA |
| Security Blue HMO-POS Deluxe (HMO-POS) | HIGHMARK CHOICE COMPANY | T2 | Yes | $95.90 | PA |
| Freedom Blue PPO Standard (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T2 | Yes | $98.20 | PA |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T2 | Yes | $115.70 | PA |
| Freedom Blue PPO Deluxe (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T2 | Yes | $122.40 | PA |
| Freedom Blue PPO Classic (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T2 | Yes | $140.90 | PA |
| Freedom Blue PPO Classic (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T2 | Yes | $145.40 | PA |
| PacificSource Medicare Essentials Rx 27 (HMO) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $0 | OR |
| PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $0 | MT |
| PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $0 | OR |
| PacificSource Medicare MyCare Rx 40 (HMO) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $0 | OR |
| PacificSource Dual Care (HMO D-SNP) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $0 | OR |
| PacificSource Dual Care Alliance (HMO D-SNP) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $0 | OR |
| PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $19.00 | ID |
| PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $29.10 | OR |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | Yes | $47.00 | PA |
| PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $52.00 | ID |
| Keystone 65 Preferred Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | Yes | $59.70 | PA |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | Yes | $63.50 | PA |
| PacificSource Medicare Essentials Rx 41 (HMO) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $69.30 | OR |
| Keystone 65 Preferred Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T4 | Yes | $79.70 | PA |
| PacificSource Medicare Explorer Rx 4 (PPO) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $88.70 | OR |
| Personal Choice 65 Rx (PPO) | QCC INSURANCE COMPANY | T4 | Yes | $102.20 | PA |
| PacificSource Medicare Essentials Rx 6 (HMO) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $105.90 | OR |
| Personal Choice 65 Rx (PPO) | QCC INSURANCE COMPANY | T4 | Yes | $112.70 | PA |
Frequently Asked Questions
Is metaxalone 400 MG Oral Tablet covered by Medicare Part D?
Yes, metaxalone 400 MG Oral Tablet is covered by 29 Medicare Part D plans (0.6% of all Part D formularies).
What tier is metaxalone 400 MG Oral Tablet on Medicare Part D plans?
metaxalone 400 MG Oral Tablet averages Tier 3 across Part D plans, ranging from Tier 2 to Tier 4.
Does metaxalone 400 MG Oral Tablet require prior authorization?
50% of Part D formularies require prior authorization for metaxalone 400 MG Oral Tablet. Step therapy: 25%. Quantity limits: 0%.
How much does Medicare spend on metaxalone 400 MG Oral Tablet?
In 2023, total Medicare Part D spending on metaxalone 400 MG Oral Tablet was $9,747,346, covering 24,167 beneficiaries. The average spend per beneficiary was $403.33.
Read our methodology - how this data is sourced, computed, and verified.