nitisinone 20 MG Oral Capsule [Orfadin]
nitisinone
RxCUI: 1799001
What the CMS Formulary Data Shows for nitisinone 20 MG Oral Capsule [Orfadin]
Per the CMS 2026 Part D formulary file, nitisinone 20 MG Oral Capsule [Orfadin] (RxNorm concept RXCUI 1799001, generic name nitisinone) appears on 7 distinct formulary files spanning 38 Medicare Part D plan offerings - 0.7% 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 3.9.
Real-world access to nitisinone 20 MG Oral Capsule [Orfadin] depends on utilization management as much as tier placement: 85.7% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry nitisinone 20 MG Oral Capsule [Orfadin] today.
Coverage Details
- Formularies covering
- 7
- Plans covering
- 38
- Coverage rate
- 0.7%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 85.7% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering nitisinone 20 MG Oral Capsule [Orfadin]
38 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| Platino Blindao (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| PLATINO ADVANCE (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| PLATINO PLUS (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $34.50 | NY |
| 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 |
| Prominence Plus (HMO) | PROMINENCE HEALTHFIRST | T5 | Yes | $0 | NV |
| Prominence Plus (HMO) | PROMINENCE HEALTHFIRST | T5 | Yes | $0 | NV |
| Prominence Dual (HMO D-SNP) | PROMINENCE HEALTHFIRST | T5 | Yes | $0 | NV |
| Prominence Dual (HMO D-SNP) | PROMINENCE HEALTHFIRST | T5 | Yes | $0 | NV |
| Prominence Giveback (HMO) | PROMINENCE HEALTHFIRST | T5 | Yes | $0 | NV |
| Prominence Plus (HMO) | PROMINENCE HEALTHFIRST OF FLORIDA INC | T5 | Yes | $0 | FL |
| Prominence Giveback (HMO) | PROMINENCE HEALTHFIRST OF FLORIDA INC | T5 | Yes | $0 | FL |
| Prominence Plus (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Plus (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Dual (HMO D-SNP) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Extra Help (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Beyond (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Giveback (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Giveback (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Dual (HMO D-SNP) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Beyond (HMO-POS) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Dual (HMO D-SNP) | PROMINENCE HEALTHFIRST OF FLORIDA INC | T5 | Yes | $0 | FL |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | PROMINENCE HEALTHFIRST | T5 | Yes | $0 | NV |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | PROMINENCE HEALTHFIRST OF FLORIDA INC | T5 | Yes | $0 | FL |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Diabetes and Heart Care Plus (HMO C-SNP) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $0 | TX |
| Prominence Extra Help (HMO) | PROMINENCE HEALTHFIRST | T5 | Yes | $4.20 | NV |
| Prominence Extra Help (HMO) | PROMINENCE HEALTHFIRST OF FLORIDA INC | T5 | Yes | $4.80 | FL |
| Prominence Extra Help (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T5 | Yes | $4.80 | TX |
| Prominence Extra Help (HMO) | PROMINENCE HEALTHFIRST | T5 | Yes | $9.50 | NV |
Frequently Asked Questions
Is nitisinone 20 MG Oral Capsule [Orfadin] covered by Medicare Part D?
Yes, nitisinone 20 MG Oral Capsule [Orfadin] is covered by 38 Medicare Part D plans (0.7% of all Part D formularies).
What tier is nitisinone 20 MG Oral Capsule [Orfadin] on Medicare Part D plans?
nitisinone 20 MG Oral Capsule [Orfadin] averages Tier 3.9 across Part D plans, ranging from Tier 1 to Tier 5.
Does nitisinone 20 MG Oral Capsule [Orfadin] require prior authorization?
85.7% of Part D formularies require prior authorization for nitisinone 20 MG Oral Capsule [Orfadin]. Step therapy: 0%. Quantity limits: 0%.
Read our methodology - how this data is sourced, computed, and verified.