Medicare Part D coverage · rufinamide · RxCUI 1092357
rufinamide 40 MG/ML Oral Suspension
Per the CMS 2026 Part D formulary file, rufinamide 40 MG/ML Oral Suspension is covered by 5,052 Medicare Part D plans (100% of enrollable products), averaging Tier 3.9, with prior authorization required on 55.2% of covering formularies.
- 100%
- Plan coverage
- 5,052
- Plans covering
- T3.9
- Avg tier
- 55.2%
- Prior auth required
What the CMS Formulary Data Shows for rufinamide 40 MG/ML Oral Suspension
Per the CMS 2026 Part D formulary file, rufinamide 40 MG/ML Oral Suspension (RxNorm concept RXCUI 1092357, generic name rufinamide) appears on 328 distinct formulary files spanning 5,052 Medicare Part D plan offerings - 100% 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 rufinamide 40 MG/ML Oral Suspension depends on utilization management as much as tier placement: 55.2% of covering formularies require prior authorization. 17.7% require step therapy. 45.4% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 2,232 Part D beneficiaries filled rufinamide 40 MG/ML Oral Suspension in 2023, with total plan-and-beneficiary spending of $39,245,407 and an average per-beneficiary annual cost of $17,583.07. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry rufinamide 40 MG/ML Oral Suspension today.
Coverage Details
- Formularies covering
- 328
- Plans covering
- 5,052
- Coverage rate
- 100%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 55.2% of formularies
- Step therapy required
- 17.7% of formularies
- Quantity limits
- 45.4% of formularies
2023 Medicare Spending
- Beneficiaries
- 2,232
- Total spending
- $39,245,407
- Avg per beneficiary
- $17,583.07
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering rufinamide 40 MG/ML Oral Suspension
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 |
| 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 |
Show the next 30 plans
| 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 |
| 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 | 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 |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| 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 |
| 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 | No | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | No | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | No | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | No | $0 | NY |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $0 | MO |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | No | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | No | $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 | No | $0 | PR |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is rufinamide 40 MG/ML Oral Suspension covered by Medicare Part D?
Yes, rufinamide 40 MG/ML Oral Suspension is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).
What tier is rufinamide 40 MG/ML Oral Suspension on Medicare Part D plans?
rufinamide 40 MG/ML Oral Suspension averages Tier 3.9 across Part D plans, ranging from Tier 1 to Tier 6.
Does rufinamide 40 MG/ML Oral Suspension require prior authorization?
55.2% of Part D formularies require prior authorization for rufinamide 40 MG/ML Oral Suspension. Step therapy: 17.7%. Quantity limits: 45.4%.
How much does Medicare spend on rufinamide 40 MG/ML Oral Suspension?
In 2023, total Medicare Part D spending on rufinamide 40 MG/ML Oral Suspension was $39,245,407, covering 2,232 beneficiaries. The average spend per beneficiary was $17,583.07.
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
- pirfenidone 267 MG Oral Tablet 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
- 24 HR selegiline 0.25 MG/HR Transdermal System [Emsam] 55.2% PA
- hydroxyzine hydrochloride 10 MG Oral Tablet 55.1% PA
- cyclobenzaprine hydrochloride 5 MG Oral Tablet 54.6% PA
- perampanel 0.5 MG/ML Oral Suspension [FYCOMPA] 54.6% PA
- eluxadoline 75 MG Oral Tablet [Viberzi] 55.9% PA
- probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah] 54.5% PA