Medicare Part D coverage · olanzapine · RxCUI 2570398
olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi]
Per the CMS 2026 Part D formulary file, olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi] is covered by 2,428 Medicare Part D plans (48.1% of enrollable products), averaging Tier 4.3, with prior authorization required on 44.1% of covering formularies.
- 48.1%
- Plan coverage
- 2,428
- Plans covering
- T4.3
- Avg tier
- 44.1%
- Prior auth required
What the CMS Formulary Data Shows for olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi]
Per the CMS 2026 Part D formulary file, olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi] (RxNorm concept RXCUI 2570398, generic name olanzapine) appears on 229 distinct formulary files spanning 2,428 Medicare Part D plan offerings - 48.1% 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 4.3.
Real-world access to olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi] depends on utilization management as much as tier placement: 44.1% of covering formularies require prior authorization. 9.6% require step therapy. 94.3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 516,737 Part D beneficiaries filled olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi] in 2023, with total plan-and-beneficiary spending of $127,379,077 and an average per-beneficiary annual cost of $246.51. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi] today.
Coverage Details
- Formularies covering
- 229
- Plans covering
- 2,428
- Coverage rate
- 48.1%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 44.1% of formularies
- Step therapy required
- 9.6% of formularies
- Quantity limits
- 94.3% of formularies
2023 Medicare Spending
- Beneficiaries
- 516,737
- Total spending
- $127,379,077
- Avg per beneficiary
- $246.51
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | No | $0 | FL |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | No | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | No | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | No | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | No | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | No | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | No | $0 | NY |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| 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 |
Show the next 30 plans
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $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 |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | No | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | No | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | No | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | No | $0 | NY |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $0 | MO |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | No | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | No | $0 | AR |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| 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 |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | Yes | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | Yes | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | Yes | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | Yes | $0 | MA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi] covered by Medicare Part D?
Yes, olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi] is covered by 2,428 Medicare Part D plans (48.1% of all Part D formularies).
What tier is olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi] on Medicare Part D plans?
olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi] averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 5.
Does olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi] require prior authorization?
44.1% of Part D formularies require prior authorization for olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi]. Step therapy: 9.6%. Quantity limits: 94.3%.
How much does Medicare spend on olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi]?
In 2023, total Medicare Part D spending on olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi] was $127,379,077, covering 516,737 beneficiaries. The average spend per beneficiary was $246.51.
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
- ceftaroline fosamil 400 MG Injection T4.3
- lomustine 100 MG Oral Capsule [Gleostine] T4.3
- 0.67 ML anakinra 149 MG/ML Prefilled Syringe [Kineret] T4.3
- sofosbuvir 400 MG / velpatasvir 100 MG Oral Tablet [Epclusa] T4.3
- 0.25 ML somatropin 4.8 MG/ML Prefilled Syringe [Genotropin] T4.3
- deferasirox 360 MG Oral Granules T4.3
Similar prior-authorization rate
- methadone hydrochloride 2 MG/ML Oral Solution 44.3% PA
- clorazepate dipotassium 15 MG Oral Tablet 43.9% PA
- 24 HR pregabalin 165 MG Extended Release Oral Tablet 43.8% PA
- prednisolone 3 MG/ML Oral Solution 44.8% PA
- methadone hydrochloride 1 MG/ML Oral Solution 43.4% PA
- anidulafungin 100 MG Injection [Eraxis] 45% PA