pitolisant 4.45 MG Oral Tablet [Wakix]
pitolisant
RxCUI: 2197890
What the CMS Formulary Data Shows for pitolisant 4.45 MG Oral Tablet [Wakix]
Per the CMS 2026 Part D formulary file, pitolisant 4.45 MG Oral Tablet [Wakix] (RxNorm concept RXCUI 2197890, 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 4.45 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 4.45 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 4.45 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 4.45 MG Oral Tablet [Wakix]
100 Medicare Advantage plans with Part D drug coverage include this drug.
Frequently Asked Questions
Is pitolisant 4.45 MG Oral Tablet [Wakix] covered by Medicare Part D?
Yes, pitolisant 4.45 MG Oral Tablet [Wakix] is covered by 146 Medicare Part D plans (2.9% of all Part D formularies).
What tier is pitolisant 4.45 MG Oral Tablet [Wakix] on Medicare Part D plans?
pitolisant 4.45 MG Oral Tablet [Wakix] averages Tier 5 across Part D plans, ranging from Tier 5 to Tier 5.
Does pitolisant 4.45 MG Oral Tablet [Wakix] require prior authorization?
85.7% of Part D formularies require prior authorization for pitolisant 4.45 MG Oral Tablet [Wakix]. Step therapy: 0%. Quantity limits: 71.4%.
How much does Medicare spend on pitolisant 4.45 MG Oral Tablet [Wakix]?
In 2023, total Medicare Part D spending on pitolisant 4.45 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.