Medicare Part D coverage · pitolisant · RxCUI 2197894
pitolisant 17.8 MG Oral Tablet [Wakix]
Per the CMS 2026 Part D formulary file, pitolisant 17.8 MG Oral Tablet [Wakix] is covered by 146 Medicare Part D plans (2.9% of enrollable products), averaging Tier 5, with prior authorization required on 85.7% of covering formularies.
- 2.9%
- Plan coverage
- 146
- Plans covering
- T5
- Avg tier
- 85.7%
- Prior auth required
What the CMS Formulary Data Shows for pitolisant 17.8 MG Oral Tablet [Wakix]
Per the CMS 2026 Part D formulary file, pitolisant 17.8 MG Oral Tablet [Wakix] (RxNorm concept RXCUI 2197894, generic name pitolisant) appears on 7 distinct formulary files spanning 146 Medicare Part D plan offerings - 2.9% 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 pitolisant 17.8 MG Oral Tablet [Wakix] depends on utilization management as much as tier placement: 85.7% of covering formularies require prior authorization. 0% require step therapy. 71.4% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 1,235 Part D beneficiaries filled pitolisant 17.8 MG Oral Tablet [Wakix] in 2023, with total plan-and-beneficiary spending of $101,374,313 and an average per-beneficiary annual cost of $82,084.46. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry pitolisant 17.8 MG Oral Tablet [Wakix] today.
Coverage Details
- Formularies covering
- 7
- Plans covering
- 146
- Coverage rate
- 2.9%
- Tier range
- Tier 5, Specialty
- Average tier
- Tier 5, Specialty
Restrictions
- Prior authorization required
- 85.7% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 71.4% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,235
- Total spending
- $101,374,313
- Avg per beneficiary
- $82,084.46
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering pitolisant 17.8 MG Oral Tablet [Wakix]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | Selecthealth, Inc. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | UT |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | NV |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | CO |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | CO |
| Select Health Medicare Flex (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | CO |
| Select Health Medicare Active (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | Selecthealth, Inc. | T5 | Yes | $0 | NV |
| Select Health Medicare Wellness (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | NV |
| Providence Medicare Extra Part B Only + Rx (HMO) | Providence Health Assurance | T5 | Yes | $0 | OR |
| Providence Medicare Prime + Rx (HMO) | Providence Health Assurance | T5 | Yes | $0 | OR |
| Providence Medicare Dual Plus (HMO D-SNP) | Providence Health Assurance | T5 | Yes | $0 | OR |
| Providence Medicare Timber + Rx (HMO) | Providence Health Assurance | T5 | Yes | $0 | OR, WA |
| Providence Medicare Pine + Rx (HMO) | Providence Health Assurance | T5 | Yes | $0 | WA |
| Providence Medicare Extra + Rx (HMO) | Providence Health Assurance | T5 | Yes | $0 | OR, WA |
Show the next 30 plans
Showing top 50 of 100 plans.
Frequently Asked Questions
Is pitolisant 17.8 MG Oral Tablet [Wakix] covered by Medicare Part D?
Yes, pitolisant 17.8 MG Oral Tablet [Wakix] is covered by 146 Medicare Part D plans (2.9% of all Part D formularies).
What tier is pitolisant 17.8 MG Oral Tablet [Wakix] on Medicare Part D plans?
pitolisant 17.8 MG Oral Tablet [Wakix] averages Tier 5 across Part D plans, ranging from Tier 5 to Tier 5.
Does pitolisant 17.8 MG Oral Tablet [Wakix] require prior authorization?
85.7% of Part D formularies require prior authorization for pitolisant 17.8 MG Oral Tablet [Wakix]. Step therapy: 0%. Quantity limits: 71.4%.
How much does Medicare spend on pitolisant 17.8 MG Oral Tablet [Wakix]?
In 2023, total Medicare Part D spending on pitolisant 17.8 MG Oral Tablet [Wakix] was $101,374,313, covering 1,235 beneficiaries. The average spend per beneficiary was $82,084.46.
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
- 0.8 ML adalimumab-adaz 100 MG/ML Auto-Injector T5
- metronidazole 10 MG/ML Topical Cream [Noritate] T5
- 1 ML ustekinumab-ttwe 90 MG/ML Prefilled Syringe T5
- formoterol fumarate 0.01 MG/ML Inhalation Solution [Perforomist] T5
- deferiprone 1000 MG Oral Tablet [Ferriprox] T5
- ruxolitinib 15 MG/ML Topical Cream [Opzelura] T5
Similar prior-authorization rate
- 0.5 ML filgrastim-ayow 0.6 MG/ML Prefilled Syringe [Releuko] 85.7% PA
- 0.8 ML filgrastim-ayow 0.6 MG/ML Prefilled Syringe [Releuko] 85.7% PA
- crinecerfont 25 MG Oral Capsule [Crenessity] 85.7% PA
- delgocitinib 20 MG/ML Topical Cream [Anzupgo] 85.7% PA
- abiraterone acetate 250 MG Oral Tablet 85.5% PA
- 60 ACTUAT testosterone 30 MG/ACTUAT Topical Solution 86% PA