Medicare Part D coverage · patiromer · RxCUI 1716215
patiromer 8400 MG Powder for Oral Suspension [Veltassa]
Per the CMS 2026 Part D formulary file, patiromer 8400 MG Powder for Oral Suspension [Veltassa] is covered by 1,719 Medicare Part D plans (34% of enrollable products), averaging Tier 2.9, with prior authorization required on 19.6% of covering formularies.
- 34%
- Plan coverage
- 1,719
- Plans covering
- T2.9
- Avg tier
- 19.6%
- Prior auth required
What the CMS Formulary Data Shows for patiromer 8400 MG Powder for Oral Suspension [Veltassa]
Per the CMS 2026 Part D formulary file, patiromer 8400 MG Powder for Oral Suspension [Veltassa] (RxNorm concept RXCUI 1716215, generic name patiromer) appears on 163 distinct formulary files spanning 1,719 Medicare Part D plan offerings - 34% 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 2.9.
Real-world access to patiromer 8400 MG Powder for Oral Suspension [Veltassa] depends on utilization management as much as tier placement: 19.6% of covering formularies require prior authorization. 0% require step therapy. 38% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 43,162 Part D beneficiaries filled patiromer 8400 MG Powder for Oral Suspension [Veltassa] in 2023, with total plan-and-beneficiary spending of $153,775,939 and an average per-beneficiary annual cost of $3,562.76. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry patiromer 8400 MG Powder for Oral Suspension [Veltassa] today.
Coverage Details
- Formularies covering
- 163
- Plans covering
- 1,719
- Coverage rate
- 34%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 19.6% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 38% of formularies
2023 Medicare Spending
- Beneficiaries
- 43,162
- Total spending
- $153,775,939
- Avg per beneficiary
- $3,562.76
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering patiromer 8400 MG Powder for Oral Suspension [Veltassa]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $0 | NJ |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | No | $0 | GA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | No | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | Yes | $0 | AL |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | No | $0 | CA |
| 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 |
Show the next 30 plans
| 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 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | No | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | No | $0 | DE |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | No | $4.80 | FL |
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | Yes | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | American Health Plan OF FL, Inc. | T1 | No | $4.80 | FL |
| SECUR Advantage (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| SECUR Enhanced (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | No | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | No | $4.80 | TX |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | No | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | No | $4.80 | TX |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | No | $8.80 | MI |
| Senior Care (HMO I-SNP) | Align Senior Care MI, LLC | T1 | Yes | $8.80 | MI |
| Tribute Select (HMO-POS I-SNP) | Arkansas Superior Select, Inc. | T1 | No | $8.90 | AR |
| AgeRight Advantage Health Plan (HMO I-SNP) | Marquis Advantage, Inc. | T1 | Yes | $10.50 | OR, WA |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | No | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | No | $10.50 | OR |
| Senior Care (HMO I-SNP) | Align Senior Care California Inc. | T1 | Yes | $12.00 | CA |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $13.10 | PA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is patiromer 8400 MG Powder for Oral Suspension [Veltassa] covered by Medicare Part D?
Yes, patiromer 8400 MG Powder for Oral Suspension [Veltassa] is covered by 1,719 Medicare Part D plans (34% of all Part D formularies).
What tier is patiromer 8400 MG Powder for Oral Suspension [Veltassa] on Medicare Part D plans?
patiromer 8400 MG Powder for Oral Suspension [Veltassa] averages Tier 2.9 across Part D plans, ranging from Tier 1 to Tier 5.
Does patiromer 8400 MG Powder for Oral Suspension [Veltassa] require prior authorization?
19.6% of Part D formularies require prior authorization for patiromer 8400 MG Powder for Oral Suspension [Veltassa]. Step therapy: 0%. Quantity limits: 38%.
How much does Medicare spend on patiromer 8400 MG Powder for Oral Suspension [Veltassa]?
In 2023, total Medicare Part D spending on patiromer 8400 MG Powder for Oral Suspension [Veltassa] was $153,775,939, covering 43,162 beneficiaries. The average spend per beneficiary was $3,562.76.
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
Similar prior-authorization rate
- fidaxomicin 40 MG/ML Oral Suspension [Dificid] 19.7% PA
- glyburide 2.5 MG / metformin hydrochloride 500 MG Oral Tablet 19.7% PA
- glyburide 1.25 MG / metformin hydrochloride 250 MG Oral Tablet 19.7% PA
- calcitriol 0.00025 MG Oral Capsule 19.5% PA
- pregabalin 100 MG Oral Capsule 19.5% PA
- pregabalin 200 MG Oral Capsule 19.5% PA