modafinil 100 MG Oral Tablet [Provigil]
modafinil
RxCUI: 226426
What the CMS Formulary Data Shows for modafinil 100 MG Oral Tablet [Provigil]
Per the CMS 2026 Part D formulary file, modafinil 100 MG Oral Tablet [Provigil] (RxNorm concept RXCUI 226426, generic name modafinil) appears on 1 distinct formulary file spanning 6 Medicare Part D plan offerings - 0.1% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 5 to Tier 5, with a cross-plan average of Tier 5.
Real-world access to modafinil 100 MG Oral Tablet [Provigil] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 69,010 Part D beneficiaries filled modafinil 100 MG Oral Tablet [Provigil] in 2023, with total plan-and-beneficiary spending of $41,700,366 and an average per-beneficiary annual cost of $604.27. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry modafinil 100 MG Oral Tablet [Provigil] today.
Coverage Details
- Formularies covering
- 1
- Plans covering
- 6
- Coverage rate
- 0.1%
- Tier range
- Tier 5, Specialty
- Average tier
- Tier 5, Specialty
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 69,010
- Total spending
- $41,700,366
- Avg per beneficiary
- $604.27
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering modafinil 100 MG Oral Tablet [Provigil]
6 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Óptimo Plus (PPO) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| Contigo Plus (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| Brillante (HMO-POS) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| Enlace Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| ContigoEnMente (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| Ahorro Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
Frequently Asked Questions
Is modafinil 100 MG Oral Tablet [Provigil] covered by Medicare Part D?
Yes, modafinil 100 MG Oral Tablet [Provigil] is covered by 6 Medicare Part D plans (0.1% of all Part D formularies).
What tier is modafinil 100 MG Oral Tablet [Provigil] on Medicare Part D plans?
modafinil 100 MG Oral Tablet [Provigil] averages Tier 5 across Part D plans, ranging from Tier 5 to Tier 5.
Does modafinil 100 MG Oral Tablet [Provigil] require prior authorization?
100% of Part D formularies require prior authorization for modafinil 100 MG Oral Tablet [Provigil]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on modafinil 100 MG Oral Tablet [Provigil]?
In 2023, total Medicare Part D spending on modafinil 100 MG Oral Tablet [Provigil] was $41,700,366, covering 69,010 beneficiaries. The average spend per beneficiary was $604.27.
Read our methodology - how this data is sourced, computed, and verified.