Medicare Part D coverage · miglustat · RxCUI 2642350
miglustat 100 MG Oral Capsule [Yargesa]
Per the CMS 2026 Part D formulary file, miglustat 100 MG Oral Capsule [Yargesa] is covered by 1,470 Medicare Part D plans (29.1% of enrollable products), averaging Tier 4.4, with prior authorization required on 97.6% of covering formularies.
- 29.1%
- Plan coverage
- 1,470
- Plans covering
- T4.4
- Avg tier
- 97.6%
- Prior auth required
What the CMS Formulary Data Shows for miglustat 100 MG Oral Capsule [Yargesa]
Per the CMS 2026 Part D formulary file, miglustat 100 MG Oral Capsule [Yargesa] (RxNorm concept RXCUI 2642350, generic name miglustat) appears on 85 distinct formulary files spanning 1,470 Medicare Part D plan offerings - 29.1% 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 4.4.
Real-world access to miglustat 100 MG Oral Capsule [Yargesa] depends on utilization management as much as tier placement: 97.6% of covering formularies require prior authorization. 0% require step therapy. 56.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 22 Part D beneficiaries filled miglustat 100 MG Oral Capsule [Yargesa] in 2023, with total plan-and-beneficiary spending of $6,614,636 and an average per-beneficiary annual cost of $300,665.26. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry miglustat 100 MG Oral Capsule [Yargesa] today.
Coverage Details
- Formularies covering
- 85
- Plans covering
- 1,470
- Coverage rate
- 29.1%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 97.6% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 56.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 22
- Total spending
- $6,614,636
- Avg per beneficiary
- $300,665.26
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering miglustat 100 MG Oral Capsule [Yargesa]
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 miglustat 100 MG Oral Capsule [Yargesa]
95 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | Yes | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | Yes | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| 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 Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $0 | MO |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | Yes | $0 | CA |
| 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 |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Hcsc Insurance Services Company | T1 | Yes | $4.80 | TX |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
Show the next 30 plans
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | Yes | $4.80 | TX |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS Insurance Company | T1 | Yes | $5.00 | OK |
| 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 |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | Yes | $17.00 | AZ |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $17.60 | PA |
| 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 |
| Hamaspik Medicare Select (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $34.50 | NY |
| 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 |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T4 | Yes | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T4 | Yes | $0 | NY |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS Choice | T4 | Yes | $51.60 | NY |
| 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 |
Showing top 50 of 95 plans.
Frequently Asked Questions
Is miglustat 100 MG Oral Capsule [Yargesa] covered by Medicare Part D?
Yes, miglustat 100 MG Oral Capsule [Yargesa] is covered by 1,470 Medicare Part D plans (29.1% of all Part D formularies).
What tier is miglustat 100 MG Oral Capsule [Yargesa] on Medicare Part D plans?
miglustat 100 MG Oral Capsule [Yargesa] averages Tier 4.4 across Part D plans, ranging from Tier 1 to Tier 5.
Does miglustat 100 MG Oral Capsule [Yargesa] require prior authorization?
97.6% of Part D formularies require prior authorization for miglustat 100 MG Oral Capsule [Yargesa]. Step therapy: 0%. Quantity limits: 56.5%.
How much does Medicare spend on miglustat 100 MG Oral Capsule [Yargesa]?
In 2023, total Medicare Part D spending on miglustat 100 MG Oral Capsule [Yargesa] was $6,614,636, covering 22 beneficiaries. The average spend per beneficiary was $300,665.26.
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
- 0.3 ML dalteparin sodium 25000 UNT/ML Prefilled Syringe [Fragmin] T4.4
- cysteamine 4.4 MG/ML Ophthalmic Solution [Cystaran] T4.4
- ceftaroline fosamil 600 MG Injection [Teflaro] T4.4
- sapropterin dihydrochloride 500 MG Powder for Oral Solution [Zelvysia] T4.4
- eliglustat 84 MG Oral Capsule [Cerdelga] T4.4
- 0.5 ML dalteparin sodium 25000 UNT/ML Prefilled Syringe [Fragmin] T4.4
Similar prior-authorization rate
- estradiol 1 MG / norethindrone acetate 0.5 MG / relugolix 40 MG Oral Tablet [Myfembree] 97.6% PA
- C1 esterase inhibitor (human) 500 UNT Injection [Cinryze] 97.6% PA
- nilotinib d-tartrate 50 MG Oral Capsule 97.6% PA
- leuprolide acetate 22.5 MG Injection [Lutrate] 97.5% PA
- alanine 5.4 MG/ML / arginine 12 MG/ML / aspartate 3.2 MG/ML / cysteine 0.16 MG/ML / glutamate 5 MG/ML / glycine 3.6 MG/ML / histidine 4.8 MG/ML / isoleucine 8.2 MG/ML / leucine 14 MG/ML / lysine 8.2 MG/ML / methionine 3.4 MG/ML / phenylalanine 4.8 MG/ML / proline 6.8 MG/ML / serine 3.8 MG/ML / taurine 0.25 MG/ML / threonine 4.2 MG/ML / tryptophan 2 MG/ML / tyrosine 2.4 MG/ML / valine 7.8 MG/ML Injectable Solution [PremaSol] 97.5% PA
- levalbuterol 0.417 MG/ML Inhalation Solution 97.7% PA