Medicare Part D coverage · nitisinone · RxCUI 1790317
nitisinone 4 MG/ML Oral Suspension [Orfadin]
Per the CMS 2026 Part D formulary file, nitisinone 4 MG/ML Oral Suspension [Orfadin] is covered by 480 Medicare Part D plans (9.5% of enrollable products), averaging Tier 4.2, with prior authorization required on 66.7% of covering formularies.
- 9.5%
- Plan coverage
- 480
- Plans covering
- T4.2
- Avg tier
- 66.7%
- Prior auth required
What the CMS Formulary Data Shows for nitisinone 4 MG/ML Oral Suspension [Orfadin]
Per the CMS 2026 Part D formulary file, nitisinone 4 MG/ML Oral Suspension [Orfadin] (RxNorm concept RXCUI 1790317, generic name nitisinone) appears on 111 distinct formulary files spanning 480 Medicare Part D plan offerings - 9.5% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 4.2.
Real-world access to nitisinone 4 MG/ML Oral Suspension [Orfadin] depends on utilization management as much as tier placement: 66.7% of covering formularies require prior authorization. 0% require step therapy. 1.8% 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 4 MG/ML Oral Suspension [Orfadin] today.
Coverage Details
- Formularies covering
- 111
- Plans covering
- 480
- Coverage rate
- 9.5%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 66.7% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 1.8% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering nitisinone 4 MG/ML Oral Suspension [Orfadin]
100 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 | No | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | No | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | No | $0 | MN |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | Yes | $0 | CA |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | Yes | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | Yes | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $0 | NY |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $0 | KY, TN |
| 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 |
Show the next 30 plans
| 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 | No | $4.80 | TX |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS Insurance Company | T1 | No | $5.00 | OK |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $13.10 | PA |
| 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 |
| Alterwood Advantage Dual Value (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $31.20 | MD |
| Highmark Health Options Duals Select (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $31.20 | DE |
| Valor Health Plan (HMO I-SNP) | TSG Guard, Inc. | T1 | Yes | $31.40 | OH |
| WV Senior Advantage (HMO I-SNP) | West Virginia Senior Advantage, Inc. | T1 | Yes | $32.70 | WV |
| Hamaspik Medicare Select (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $34.50 | NY |
| Abilis Health (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $35.90 | KY, TN |
| CommuniCare Advantage ISNP (HMO I-SNP) | OH CHS SNP Inc. | T1 | Yes | $38.40 | IN, MD, OH |
| Nascentia Skilled Nursing Facility (HMO I-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $58.80 | NY |
| 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 |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | Selecthealth, Inc. | T5 | Yes | $0 | UT |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is nitisinone 4 MG/ML Oral Suspension [Orfadin] covered by Medicare Part D?
Yes, nitisinone 4 MG/ML Oral Suspension [Orfadin] is covered by 480 Medicare Part D plans (9.5% of all Part D formularies).
What tier is nitisinone 4 MG/ML Oral Suspension [Orfadin] on Medicare Part D plans?
nitisinone 4 MG/ML Oral Suspension [Orfadin] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 6.
Does nitisinone 4 MG/ML Oral Suspension [Orfadin] require prior authorization?
66.7% of Part D formularies require prior authorization for nitisinone 4 MG/ML Oral Suspension [Orfadin]. Step therapy: 0%. Quantity limits: 1.8%.
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
- {32 (24 HR gepirone 18.2 MG Extended Release Oral Tablet [Exxua]) } Pack [Exxua Titration Pack] T4.2
- chlorambucil 2 MG Oral Tablet [Leukeran] T4.2
- 1.6 ML aripiprazole lauroxil 276 MG/ML Prefilled Syringe [Aristada] T4.2
- 2.4 ML aripiprazole lauroxil 276 MG/ML Prefilled Syringe [Aristada] T4.2
- 3.2 ML aripiprazole lauroxil 276 MG/ML Prefilled Syringe [Aristada] T4.2
- 3.9 ML aripiprazole lauroxil 273 MG/ML Prefilled Syringe [Aristada] T4.2
Similar prior-authorization rate
- meperidine hydrochloride 10 MG/ML Oral Solution 66.7% PA
- tretinoin 0.25 MG/ML Topical Cream [Retin-A] 66.7% PA
- 1 ML meperidine hydrochloride 25 MG/ML Injection 66.7% PA
- tazarotene 0.5 MG/ML Topical Cream [Tazorac] 66.7% PA
- Modified 24 HR metformin hydrochloride 500 MG Extended Release Oral Tablet 66.7% PA
- 0.2 ML adalimumab-atto 100 MG/ML Prefilled Syringe [Amjevita] 66.7% PA