Medicare Part D coverage · naldemedine · RxCUI 1876609
naldemedine 0.2 MG Oral Tablet [Symproic]
Per the CMS 2026 Part D formulary file, naldemedine 0.2 MG Oral Tablet [Symproic] is covered by 166 Medicare Part D plans (3.3% of enrollable products), averaging Tier 2.7, with prior authorization required on 16.7% of covering formularies.
- 3.3%
- Plan coverage
- 166
- Plans covering
- T2.7
- Avg tier
- 16.7%
- Prior auth required
What the CMS Formulary Data Shows for naldemedine 0.2 MG Oral Tablet [Symproic]
Per the CMS 2026 Part D formulary file, naldemedine 0.2 MG Oral Tablet [Symproic] (RxNorm concept RXCUI 1876609, generic name naldemedine) appears on 30 distinct formulary files spanning 166 Medicare Part D plan offerings - 3.3% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.7.
Real-world access to naldemedine 0.2 MG Oral Tablet [Symproic] depends on utilization management as much as tier placement: 16.7% of covering formularies require prior authorization. 0% require step therapy. 96.7% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 5,113 Part D beneficiaries filled naldemedine 0.2 MG Oral Tablet [Symproic] in 2023, with total plan-and-beneficiary spending of $11,899,468 and an average per-beneficiary annual cost of $2,327.30. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry naldemedine 0.2 MG Oral Tablet [Symproic] today.
Coverage Details
- Formularies covering
- 30
- Plans covering
- 166
- Coverage rate
- 3.3%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 16.7% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 96.7% of formularies
2023 Medicare Spending
- Beneficiaries
- 5,113
- Total spending
- $11,899,468
- Avg per beneficiary
- $2,327.30
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering naldemedine 0.2 MG Oral Tablet [Symproic]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $0 | NJ |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | No | $0 | GA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | No | $0 | MI |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | No | $4.80 | FL |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | No | $8.80 | MI |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Illinois, Inc. | T1 | No | $15.20 | IL |
| WellSense Added Value (HMO) | Boston Medical Center Health Plan, Inc. | T1 | No | $21.70 | NH |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Colorado, Inc. | T1 | No | $35.20 | CO |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF North Carolina, Inc. | T1 | No | $36.20 | NC |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $40.00 | NJ |
| ElderServe Star (HMO I-SNP) | Elderserve Health, Inc. | T1 | No | $58.80 | NY |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF NEW York, Inc. | T1 | No | $58.80 | NY |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T3 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T3 | No | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | Selecthealth, Inc. | T3 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T3 | No | $0 | UT |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T3 | No | $0 | NV |
Show the next 30 plans
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T3 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T3 | No | $0 | CO |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T3 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T3 | No | $0 | CO |
| Select Health Medicare Flex (HMO) | Selecthealth, Inc. | T3 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T3 | No | $0 | CO |
| Select Health Medicare Active (HMO) | Selecthealth, Inc. | T3 | No | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | Selecthealth, Inc. | T3 | No | $0 | NV |
| Select Health Medicare Wellness (HMO) | Selecthealth, Inc. | T3 | No | $0 | NV |
| The Health Plan SecureCare - Option II (HMO) | THE Health Plan OF West Virginia, Inc. | T3 | No | $0 | OH |
| The Health Plan SecureCare - Option II (HMO) | THE Health Plan OF West Virginia, Inc. | T3 | No | $0 | OH, WV |
| The Health Plan SecureCare Capitol Plan (HMO) | THE Health Plan OF West Virginia, Inc. | T3 | No | $0 | WV |
| The Health Plan SecureChoice Optimum (PPO) | THP Insurance Company | T3 | No | $0 | OH, WV |
| HAP Medicare Explore (PPO) | Alliance Health AND Life Insurance Company | T3 | Yes | $0 | MI |
| HAP Medicare Prime (PPO) | Alliance Health AND Life Insurance Company | T3 | Yes | $0 | MI |
| HAP Medicare Connect (HMO) | Health Alliance Plan OF Michigan | T3 | Yes | $0 | MI |
| HAP Medicare Complete Duals (HMO D-SNP) | Health Alliance Plan OF Michigan | T3 | Yes | $0 | MI |
| HAP Medicare Superior (HMO) | Health Alliance Plan OF Michigan | T3 | Yes | $0 | MI |
| Henry Ford Select (HMO) | Health Alliance Plan OF Michigan | T3 | Yes | $0 | MI |
| WellSense Signature (HMO) | Boston Medical Center Health Plan, Inc. | T3 | No | $0 | NH |
| WellSense Signature Access (PPO) | Boston Medical Center Health Plan, Inc. | T3 | No | $0 | NH |
| Community Health Plan of WA Dual Complete (HMO D-SNP) | Community Health Plan OF Washington | T3 | No | $0 | WA |
| Community Health Plan of WA Dual Select (HMO D-SNP) | Community Health Plan OF Washington | T3 | No | $0 | WA |
| Essence Advantage (HMO) | Essence Healthcare, Inc. | T3 | No | $0 | IL, MO |
| Essence Advantage (HMO) | Essence Healthcare, Inc. | T3 | No | $0 | AR, MO |
| Essence Advantage Select (HMO) | Essence Healthcare, Inc. | T3 | No | $0 | IL, MO |
| Essence Advantage (HMO) | Essence Healthcare, Inc. | T3 | No | $0 | IN, KY |
| Essence Advantage Select (HMO) | Essence Healthcare, Inc. | T3 | No | $0 | IL |
| Essence Advantage Choice (PPO) | Essence Healthcare PPO, Inc. | T3 | No | $0 | IL, MO |
| Essence Advantage Choice (PPO) | Essence Healthcare PPO, Inc. | T3 | No | $0 | AR, MO |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is naldemedine 0.2 MG Oral Tablet [Symproic] covered by Medicare Part D?
Yes, naldemedine 0.2 MG Oral Tablet [Symproic] is covered by 166 Medicare Part D plans (3.3% of all Part D formularies).
What tier is naldemedine 0.2 MG Oral Tablet [Symproic] on Medicare Part D plans?
naldemedine 0.2 MG Oral Tablet [Symproic] averages Tier 2.7 across Part D plans, ranging from Tier 1 to Tier 4.
Does naldemedine 0.2 MG Oral Tablet [Symproic] require prior authorization?
16.7% of Part D formularies require prior authorization for naldemedine 0.2 MG Oral Tablet [Symproic]. Step therapy: 0%. Quantity limits: 96.7%.
How much does Medicare spend on naldemedine 0.2 MG Oral Tablet [Symproic]?
In 2023, total Medicare Part D spending on naldemedine 0.2 MG Oral Tablet [Symproic] was $11,899,468, covering 5,113 beneficiaries. The average spend per beneficiary was $2,327.30.
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
- tadalafil 5 MG Oral Tablet T2.7
- theophylline 300 MG Extended Release Oral Tablet T2.7
- ampicillin 100 MG/ML Injectable Solution T2.7
- timolol 20 MG Oral Tablet T2.7
- 1000 ML glucose 50 MG/ML / potassium chloride 0.02 MEQ/ML / sodium chloride 4.5 MG/ML Injection T2.7
- 20 ML potassium chloride 2 MEQ/ML Injection T2.7
Similar prior-authorization rate
- quetiapine 150 MG Oral Tablet 16.7% PA
- ziprasidone 20 MG Injection 16.8% PA
- morphine sulfate 20 MG/ML Oral Solution 16.9% PA
- chlorpromazine hydrochloride 100 MG Oral Tablet 16.5% PA
- chlorpromazine hydrochloride 50 MG Oral Tablet 16.5% PA
- 1000 ML glucose 100 MG/ML / sodium chloride 4.5 MG/ML Injection 16.5% PA