Medicare Part D coverage · pirfenidone · RxCUI 1868014
pirfenidone 267 MG Oral Tablet
Per the CMS 2026 Part D formulary file, pirfenidone 267 MG Oral Tablet is covered by 5,010 Medicare Part D plans (99.2% of enrollable products), averaging Tier 3.9, with prior authorization required on 99.7% of covering formularies.
- 99.2%
- Plan coverage
- 5,010
- Plans covering
- T3.9
- Avg tier
- 99.7%
- Prior auth required
What the CMS Formulary Data Shows for pirfenidone 267 MG Oral Tablet
Per the CMS 2026 Part D formulary file, pirfenidone 267 MG Oral Tablet (RxNorm concept RXCUI 1868014, generic name pirfenidone) appears on 322 distinct formulary files spanning 5,010 Medicare Part D plan offerings - 99.2% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 3.9.
Real-world access to pirfenidone 267 MG Oral Tablet depends on utilization management as much as tier placement: 99.7% of covering formularies require prior authorization. 0% require step therapy. 89.4% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 7,776 Part D beneficiaries filled pirfenidone 267 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 267 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 322
- Plans covering
- 5,010
- Coverage rate
- 99.2%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 99.7% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 89.4% 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 267 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 |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | Yes | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | Yes | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | Yes | $0 | NJ |
| 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 |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | Yes | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | Yes | $0 | GA |
| 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 |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | Yes | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $0 | GA |
Show the next 30 plans
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | Yes | $0 | AL |
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T1 | Yes | $0 | CA |
| 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 |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $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 | 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 |
| 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 |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Advance (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is pirfenidone 267 MG Oral Tablet covered by Medicare Part D?
Yes, pirfenidone 267 MG Oral Tablet is covered by 5,010 Medicare Part D plans (99.2% of all Part D formularies).
What tier is pirfenidone 267 MG Oral Tablet on Medicare Part D plans?
pirfenidone 267 MG Oral Tablet averages Tier 3.9 across Part D plans, ranging from Tier 1 to Tier 6.
Does pirfenidone 267 MG Oral Tablet require prior authorization?
99.7% of Part D formularies require prior authorization for pirfenidone 267 MG Oral Tablet. Step therapy: 0%. Quantity limits: 89.4%.
How much does Medicare spend on pirfenidone 267 MG Oral Tablet?
In 2023, total Medicare Part D spending on pirfenidone 267 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
- rufinamide 40 MG/ML Oral Suspension T3.9
- 24 HR tacrolimus 4 MG Extended Release Oral Tablet [Envarsus] T3.9
- betamethasone dipropionate 0.000643 MG/MG / calcipotriene 0.00005 MG/MG Topical Ointment T3.9
- daptomycin 500 MG Injection T3.9
- emtricitabine 133 MG / tenofovir disoproxil fumarate 200 MG Oral Tablet T3.9
- 0.6 ML fondaparinux sodium 12.5 MG/ML Prefilled Syringe T3.9
Similar prior-authorization rate
- ipratropium bromide 0.2 MG/ML Inhalation Solution 99.7% PA
- albuterol 0.83 MG/ML Inhalation Solution 99.7% PA
- albuterol 0.833 MG/ML / ipratropium bromide 0.167 MG/ML Inhalation Solution 99.7% PA
- albuterol 5 MG/ML Inhalation Solution 99.7% PA
- albuterol 0.417 MG/ML Inhalation Solution 99.7% PA
- cromolyn sodium 10 MG/ML Inhalation Solution 99.7% PA