Medicare Part D coverage · sodium oxybate · RxCUI 2636836
sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz]
Per the CMS 2026 Part D formulary file, sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz] is covered by 1,016 Medicare Part D plans (20.1% of enrollable products), averaging Tier 3.8, with prior authorization required on 100% of covering formularies.
- 20.1%
- Plan coverage
- 1,016
- Plans covering
- T3.8
- Avg tier
- 100%
- Prior auth required
What the CMS Formulary Data Shows for sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz]
Per the CMS 2026 Part D formulary file, sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz] (RxNorm concept RXCUI 2636836, generic name sodium oxybate) appears on 54 distinct formulary files spanning 1,016 Medicare Part D plan offerings - 20.1% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 3.8.
Real-world access to sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 100% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 855 Part D beneficiaries filled sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz] in 2023, with total plan-and-beneficiary spending of $98,471,849 and an average per-beneficiary annual cost of $115,171.75. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz] today.
Coverage Details
- Formularies covering
- 54
- Plans covering
- 1,016
- Coverage rate
- 20.1%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 100% of formularies
2023 Medicare Spending
- Beneficiaries
- 855
- Total spending
- $98,471,849
- Avg per beneficiary
- $115,171.75
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz]
5 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T5 | Yes | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz]
95 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| 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 |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | Yes | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | American Health Plan OF FL, Inc. | T1 | Yes | $4.80 | FL |
| SECUR Advantage (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| SECUR Enhanced (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Hcsc Insurance Services Company | T1 | Yes | $4.80 | TX |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS Insurance Company | T1 | Yes | $5.00 | OK |
| Senior Care (HMO I-SNP) | Align Senior Care MI, LLC | T1 | Yes | $8.80 | MI |
| AgeRight Advantage Health Plan (HMO I-SNP) | Marquis Advantage, Inc. | T1 | Yes | $10.50 | OR, WA |
| Senior Care (HMO I-SNP) | Align Senior Care California Inc. | T1 | Yes | $12.00 | CA |
| Liberty Medicare Dual Plan (HMO D-SNP) | Liberty Advantage, LLC | T1 | Yes | $14.70 | NC |
| KeyCare Advantage (HMO I-SNP) | Isnp Ventures, LLC | T1 | Yes | $23.20 | MD |
Show the next 30 plans
| American Health Advantage of Mississippi (HMO I-SNP) | American Health Plan OF MS, Inc. | T1 | Yes | $23.80 | MS |
| Senior Care (HMO I-SNP) | Lifeworks Advantage, LLC | T1 | Yes | $24.60 | VA |
| PruittHealth Premier (HMO I-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $25.40 | GA |
| Georgia Health Advantage (HMO I-SNP) | Georgia Assurance, Inc. | T1 | Yes | $25.40 | GA |
| Georgia Health Advantage Choice (HMO I-SNP) | Georgia Assurance, Inc. | T1 | Yes | $25.40 | GA |
| American Health Advantage of Tennessee (HMO I-SNP) | American Health Plan, Inc. | T1 | Yes | $27.70 | TN |
| Simpra Advantage Nursing Home Plan (PPO I-SNP) | Simpra Advantage, Inc. | T1 | Yes | $27.70 | AL |
| American Health Advantage of Oklahoma (HMO I-SNP) | Oklahoma Superior Select, Inc. | T1 | Yes | $28.20 | OK |
| NHC Advantage (HMO I-SNP) | NHC Advantage, LLC | T1 | Yes | $31.00 | MO, NC, SC, TN |
| Perennial Advantage Strive (HMO I-SNP) | Perennial Advantage OF Ohio, Inc. | T1 | Yes | $31.40 | OH |
| Perennial Advantage Strive (HMO I-SNP) | Perennial Advantage OF Colorado, Inc. | T1 | Yes | $32.70 | PA |
| American Health Advantage of Pennsylvania (HMO I-SNP) | American Health Plan OF Pennsylvania Inc | T1 | Yes | $32.70 | PA |
| Lagniappe Advantage (PPO I-SNP) | Lagniappe Advantage Insurance Company | T1 | Yes | $32.90 | LA |
| American Health Advantage of Louisiana (HMO I-SNP) | Dignity Care Corporation | T1 | Yes | $32.90 | LA |
| Hamaspik Medicare Select (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $34.50 | NY |
| Perennial Advantage Strive (HMO I-SNP) | Perennial Advantage OF Colorado, Inc. | T1 | Yes | $35.20 | CO |
| PruittHealth Premier (HMO I-SNP) | Pruitthealth Premier North Carolina, LLC | T1 | Yes | $35.70 | SC |
| PruittHealth Premier (HMO I-SNP) | Pruitthealth Premier North Carolina, LLC | T1 | Yes | $36.20 | NC |
| Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) | Liberty Advantage, LLC | T1 | Yes | $36.20 | NC |
| American Health Advantage of Utah (HMO I-SNP) | American Health Plan OF UT, Inc. | T1 | Yes | $37.60 | UT |
| American Health Advantage of Idaho (HMO I-SNP) | American Health Plan OF UT, Inc. | T1 | Yes | $37.60 | ID |
| American Health Advantage of Indiana (HMO I-SNP) | American Health Plan OF Indiana Inc | T1 | Yes | $38.40 | IN |
| Iowa Health Advantage (HMO I-SNP) | American Health Plan OF Iowa Inc | T1 | Yes | $41.50 | IA |
| Iowa Health Advantage Choice (HMO I-SNP) | American Health Plan OF Iowa Inc | T1 | Yes | $41.50 | IA |
| American Health Advantage of Missouri (HMO I-SNP) | American Health Plan OF Missouri, Inc. | T1 | Yes | $43.00 | MO |
| American Health Advantage of Missouri Choice (HMO I-SNP) | American Health Plan OF Missouri, Inc. | T1 | Yes | $43.00 | MO |
| Kansas Health Advantage (HMO I-SNP) | Kansas Superior Select, Inc. | T1 | Yes | $55.20 | KS |
| Kansas Health Advantage Choice (HMO I-SNP) | Kansas Superior Select, Inc. | T1 | Yes | $55.20 | KS |
| UHC Dual Complete IA-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T5 | Yes | $0 | IA |
| UHC Dual Complete MO-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T5 | Yes | $0 | MO |
Showing top 50 of 95 plans.
Frequently Asked Questions
Is sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz] covered by Medicare Part D?
Yes, sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz] is covered by 1,016 Medicare Part D plans (20.1% of all Part D formularies).
What tier is sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz] on Medicare Part D plans?
sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz] averages Tier 3.8 across Part D plans, ranging from Tier 1 to Tier 6.
Does sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz] require prior authorization?
100% of Part D formularies require prior authorization for sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz]. Step therapy: 0%. Quantity limits: 100%.
How much does Medicare spend on sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz]?
In 2023, total Medicare Part D spending on sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz] was $98,471,849, covering 855 beneficiaries. The average spend per beneficiary was $115,171.75.
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
- fluorouracil 5 MG/ML Topical Cream T3.8
- sofosbuvir 400 MG Oral Tablet [Sovaldi] T3.8
- 24 HR oxcarbazepine 600 MG Extended Release Oral Tablet T3.8
- {2 (0.1 ML) (diazepam 100 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 20 MG Dose Kit] T3.8
- alosetron 1 MG Oral Tablet T3.8
- clobazam 5 MG Oral Film [Sympazan] T3.8
Similar prior-authorization rate
- azathioprine 50 MG Oral Tablet 100% PA
- 0.5 ML hepatitis B surface antigen vaccine 0.04 MG/ML Prefilled Syringe [Heplisav-B] 100% PA
- 0.5 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] 100% PA
- 1 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] 100% PA
- sotagliflozin 200 MG Oral Tablet [Inpefa] 100% PA
- mycophenolate mofetil 250 MG Oral Capsule 100% PA