miglustat 100 MG Oral Capsule [Yargesa]
miglustat
RxCUI: 2642350
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 86 distinct formulary files spanning 1,484 Medicare Part D plan offerings - 29.3% 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: 97.7% of covering formularies require prior authorization. 0% require step therapy. 55.8% 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
- 86
- Plans covering
- 1,484
- Coverage rate
- 29.3%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 97.7% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 55.8% 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 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 |
| 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 |
| 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 |
| 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 |
| 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 |
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 1,484 Medicare Part D plans (29.3% 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?
97.7% of Part D formularies require prior authorization for miglustat 100 MG Oral Capsule [Yargesa]. Step therapy: 0%. Quantity limits: 55.8%.
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.