Medicare Part D coverage · pirfenidone · RxCUI 2606490
pirfenidone 534 MG Oral Tablet
Per the CMS 2026 Part D formulary file, pirfenidone 534 MG Oral Tablet is covered by 3,315 Medicare Part D plans (65.6% of enrollable products), averaging Tier 4.3, with prior authorization required on 99.5% of covering formularies.
- 65.6%
- Plan coverage
- 3,315
- Plans covering
- T4.3
- Avg tier
- 99.5%
- Prior auth required
What the CMS Formulary Data Shows for pirfenidone 534 MG Oral Tablet
Per the CMS 2026 Part D formulary file, pirfenidone 534 MG Oral Tablet (RxNorm concept RXCUI 2606490, generic name pirfenidone) appears on 200 distinct formulary files spanning 3,315 Medicare Part D plan offerings - 65.6% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 4.3.
Real-world access to pirfenidone 534 MG Oral Tablet depends on utilization management as much as tier placement: 99.5% of covering formularies require prior authorization. 0% require step therapy. 82.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 7,776 Part D beneficiaries filled pirfenidone 534 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $169,409,564 and an average per-beneficiary annual cost of $21,786.21. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry pirfenidone 534 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 200
- Plans covering
- 3,315
- Coverage rate
- 65.6%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 99.5% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 82.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 7,776
- Total spending
- $169,409,564
- Avg per beneficiary
- $21,786.21
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering pirfenidone 534 MG Oral Tablet
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | Yes | $0 | NY |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| 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 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | Yes | $0 | CO |
Show the next 30 plans
| 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 |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | Yes | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | Yes | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $0 | MO |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $0 | AR |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | Yes | $0 | CA |
| 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 |
| Florida Complete Care (HMO I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | Yes | $4.80 | TX |
| 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 |
| Tribute Select (HMO-POS I-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $8.90 | AR |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is pirfenidone 534 MG Oral Tablet covered by Medicare Part D?
Yes, pirfenidone 534 MG Oral Tablet is covered by 3,315 Medicare Part D plans (65.6% of all Part D formularies).
What tier is pirfenidone 534 MG Oral Tablet on Medicare Part D plans?
pirfenidone 534 MG Oral Tablet averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 6.
Does pirfenidone 534 MG Oral Tablet require prior authorization?
99.5% of Part D formularies require prior authorization for pirfenidone 534 MG Oral Tablet. Step therapy: 0%. Quantity limits: 82.5%.
How much does Medicare spend on pirfenidone 534 MG Oral Tablet?
In 2023, total Medicare Part D spending on pirfenidone 534 MG Oral Tablet was $169,409,564, covering 7,776 beneficiaries. The average spend per beneficiary was $21,786.21.
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
- sapropterin dihydrochloride 100 MG Powder for Oral Solution T4.3
- C1 esterase inhibitor (human) 2000 UNT Injection [Haegarda] T4.3
- tolvaptan 15 MG Oral Tablet T4.3
- perampanel 0.5 MG/ML Oral Suspension [FYCOMPA] T4.3
- 0.5 ML ustekinumab 90 MG/ML Prefilled Syringe [Stelara] T4.3
- 1 ML ustekinumab 90 MG/ML Prefilled Syringe [Stelara] T4.3
Similar prior-authorization rate
- valbenazine 40 MG Oral Capsule [Ingrezza] 99.5% PA
- {7 (valbenazine 40 MG Oral Capsule [Ingrezza]) / 21 (valbenazine 80 MG Oral Capsule [Ingrezza]) } Pack [Ingrezza] 99.5% PA
- {10 (avatrombopag 20 MG Oral Tablet [Doptelet]) } Pack [Doptelet 40 MG Daily Dose Carton] 99.5% PA
- {15 (avatrombopag 20 MG Oral Tablet [Doptelet]) } Pack [Doptelet 60 MG Daily Dose Carton] 99.5% PA
- avatrombopag 20 MG Oral Tablet [Doptelet] 99.5% PA
- granisetron 1 MG Oral Tablet 99.6% PA