paltusotine 20 MG Oral Tablet [Palsonify]
paltusotine
RxCUI: 2724409
What the CMS Formulary Data Shows for paltusotine 20 MG Oral Tablet [Palsonify]
Per the CMS 2026 Part D formulary file, paltusotine 20 MG Oral Tablet [Palsonify] (RxNorm concept RXCUI 2724409, generic name paltusotine) appears on 2 distinct formulary files spanning 15 Medicare Part D plan offerings - 0.3% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 5 to Tier 5, with a cross-plan average of Tier 5.
Real-world access to paltusotine 20 MG Oral Tablet [Palsonify] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 100% 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 paltusotine 20 MG Oral Tablet [Palsonify] today.
Coverage Details
- Formularies covering
- 2
- Plans covering
- 15
- Coverage rate
- 0.3%
- Tier range
- Tier 5, Specialty
- Average tier
- Tier 5, Specialty
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 100% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering paltusotine 20 MG Oral Tablet [Palsonify]
15 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| UPMC for Life HMO Premier Rx (HMO) | UPMC HEALTH PLAN, INC. | T5 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC FOR YOU, INC | T5 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC FOR YOU, INC | T5 | Yes | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $0 | PA |
| UPMC for Life PPO Essential Care Rx (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC HEALTH COVERAGE, INC. | T5 | Yes | $0 | PA |
| UPMC for Life HMO Rx Choice (HMO) | UPMC HEALTH PLAN, INC. | T5 | Yes | $3.90 | OH, PA |
| UPMC for Life HMO Deductible Rx (HMO) | UPMC HEALTH PLAN, INC. | T5 | Yes | $18.10 | OH, PA |
| UPMC for Life PPO Rx Choice (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $25.00 | PA |
| UPMC for Life PPO High Deductible Rx (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $33.00 | PA |
| UPMC for Life HMO Rx (HMO) | UPMC HEALTH PLAN, INC. | T5 | Yes | $33.70 | OH, PA |
| UPMC for Life PPO Rx Enhanced (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $42.70 | PA |
| UPMC for Life HMO Rx Enhanced (HMO) | UPMC HEALTH PLAN, INC. | T5 | Yes | $93.40 | OH, PA |
| UPMC for Life PPO Rx Enhanced (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $140.00 | PA |
Frequently Asked Questions
Is paltusotine 20 MG Oral Tablet [Palsonify] covered by Medicare Part D?
Yes, paltusotine 20 MG Oral Tablet [Palsonify] is covered by 15 Medicare Part D plans (0.3% of all Part D formularies).
What tier is paltusotine 20 MG Oral Tablet [Palsonify] on Medicare Part D plans?
paltusotine 20 MG Oral Tablet [Palsonify] averages Tier 5 across Part D plans, ranging from Tier 5 to Tier 5.
Does paltusotine 20 MG Oral Tablet [Palsonify] require prior authorization?
100% of Part D formularies require prior authorization for paltusotine 20 MG Oral Tablet [Palsonify]. Step therapy: 0%. Quantity limits: 100%.
Read our methodology - how this data is sourced, computed, and verified.