Skip to main content

Independent; not a government site. Official answers: Medicare.gov, 1-800-MEDICARE.

PlainMedicare

Is paliperidone covered by Medicare Part D?

5,052 of 5,052 Medicare Part D plan offerings (100%) list paliperidone on their 2026 formulary, most often on tier 4; 17.7% of the formularies that cover it require prior authorization. Part D spending on it was $78 million in 2024 for 52,243 people: what plans and patients paid at the pharmacy, before manufacturer rebates (CMS Part D Spending by Drug).

Plans that cover it
100%
5,052 of 5,052 offerings; the median drug: 76%
Usual tier
Tier 4
from tier 1 to tier 4
Prior authorization
17.7%
of formularies that cover it; the median drug: 1%
Quantity limits
95.1%
of formularies that cover it; the median drug: 30%

1.5% of the formularies that cover it require step therapy (trying another drug first).

Source: CMS Part D formulary file, 2026 second quarter: the formularies in use in 2026. A plan's 2027 formulary can differ; check your own plan's coverage in Medicare Plan Finder.

What does it cost under Part D in 2027?

Your yearly cap in 2027
Out-of-pocket spending on covered Part D drugs stops at $2,400 in 2027 ($2,100 in 2026); after that, you pay nothing for covered drugs for the rest of the year.
The deductible
A plan's drug deductible is at most $700 in 2027 ($615 in 2026); many plans charge less or none.

Source: CMS, Announcement of calendar year 2027 Part D parameters; Medicare.gov, “How much does Medicare drug coverage cost?” (read Oct. 7, 2026).

How much does Medicare spend on it?

Part D spending by year

2020$148 million
2021$137 million
2022$140 million
2023$143 million
2024 (latest)$78 million

52,243 people filled it under Part D in 2024, in 392,711 claims. The amounts are what plans and patients paid at the pharmacy, before manufacturer rebates.

Source: CMS Medicare Part D Spending by Drug, 2020 to 2024 (published June 2026). Row used: Paliperidone ER (Paliperidone).

Which forms and strengths are counted?

  • 24 hour paliperidone 1.5 mg extended-release oral tablet
  • 24 hour paliperidone 3 mg extended-release oral tablet
  • 24 hour paliperidone 6 mg extended-release oral tablet
  • 24 hour paliperidone 9 mg extended-release oral tablet

What else should you check?

Data, not medical advice. Coverage is the share of plan formularies listing the drug; your plan's formulary, tier and pharmacy decide what you pay.