pretomanid 200 MG Oral Tablet
pretomanid
RxCUI: 2198370
What the CMS Formulary Data Shows for pretomanid 200 MG Oral Tablet
Per the CMS 2026 Part D formulary file, pretomanid 200 MG Oral Tablet (RxNorm concept RXCUI 2198370, generic name pretomanid) appears on 81 distinct formulary files spanning 1,134 Medicare Part D plan offerings - 22.4% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 3.5.
Real-world access to pretomanid 200 MG Oral Tablet depends on utilization management as much as tier placement: 33.3% of covering formularies require prior authorization. 0% require step therapy. 19.8% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 18 Part D beneficiaries filled pretomanid 200 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $55,772 and an average per-beneficiary annual cost of $3,098.43. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry pretomanid 200 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 81
- Plans covering
- 1,134
- Coverage rate
- 22.4%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 33.3% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 19.8% of formularies
2023 Medicare Spending
- Beneficiaries
- 18
- Total spending
- $55,772
- Avg per beneficiary
- $3,098.43
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering pretomanid 200 MG Oral Tablet
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | SENTARA HEALTH PLANS | T1 | Yes | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | SENTARA HEALTH PLANS | T1 | Yes | $0 | VA |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | No | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | HORIZON HEALTHCARE OF NEW JERSEY, INC. | T1 | No | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | No | $0 | MN |
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $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 |
| 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 |
| PLATINO PLUS (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | HCSC INSURANCE SERVICES COMPANY | T1 | No | $4.80 | TX |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS INSURANCE COMPANY | T1 | No | $5.00 | OK |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $34.50 | NY |
| Óptimo Plus (PPO) | TRIPLE S ADVANTAGE, INC. | T2 | Yes | $0 | PR |
| Contigo Plus (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T2 | Yes | $0 | PR |
| Brillante (HMO-POS) | TRIPLE S ADVANTAGE, INC. | T2 | Yes | $0 | PR |
| Enlace Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T2 | Yes | $0 | PR |
| ContigoEnMente (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T2 | Yes | $0 | PR |
| Ahorro Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T2 | Yes | $0 | PR |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T3 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T3 | Yes | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T3 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T3 | Yes | $0 | UT |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T3 | Yes | $0 | NV |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T3 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T3 | Yes | $0 | CO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T3 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T3 | Yes | $0 | CO |
| Select Health Medicare Flex (HMO) | SELECTHEALTH, INC. | T3 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T3 | Yes | $0 | CO |
| Select Health Medicare Active (HMO) | SELECTHEALTH, INC. | T3 | Yes | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T3 | Yes | $0 | NV |
| Select Health Medicare Wellness (HMO) | SELECTHEALTH, INC. | T3 | Yes | $0 | NV |
| Healthy Mississippi Premier Advantage (HMO-POS) | Healthy Mississippi, Inc. | T3 | Yes | $0 | MS |
| Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Enhanced Solano (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Inland Empire (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Ventura (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Enhanced Kern (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Basic Kern (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Senior Advantage San Diego (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) | KAISER FOUNDATION HP, INC. | T3 | No | $0 | CA |
Frequently Asked Questions
Is pretomanid 200 MG Oral Tablet covered by Medicare Part D?
Yes, pretomanid 200 MG Oral Tablet is covered by 1,134 Medicare Part D plans (22.4% of all Part D formularies).
What tier is pretomanid 200 MG Oral Tablet on Medicare Part D plans?
pretomanid 200 MG Oral Tablet averages Tier 3.5 across Part D plans, ranging from Tier 1 to Tier 4.
Does pretomanid 200 MG Oral Tablet require prior authorization?
33.3% of Part D formularies require prior authorization for pretomanid 200 MG Oral Tablet. Step therapy: 0%. Quantity limits: 19.8%.
How much does Medicare spend on pretomanid 200 MG Oral Tablet?
In 2023, total Medicare Part D spending on pretomanid 200 MG Oral Tablet was $55,772, covering 18 beneficiaries. The average spend per beneficiary was $3,098.43.
Read our methodology - how this data is sourced, computed, and verified.