Medicare Part D coverage · sodium oxybate · RxCUI 352257
sodium oxybate 500 MG/ML Oral Solution [Xyrem]
Per the CMS 2026 Part D formulary file, sodium oxybate 500 MG/ML Oral Solution [Xyrem] is covered by 38 Medicare Part D plans (0.8% of enrollable products), averaging Tier 5, with prior authorization required on 100% of covering formularies.
- 0.8%
- Plan coverage
- 38
- Plans covering
- T5
- Avg tier
- 100%
- Prior auth required
What the CMS Formulary Data Shows for sodium oxybate 500 MG/ML Oral Solution [Xyrem]
Per the CMS 2026 Part D formulary file, sodium oxybate 500 MG/ML Oral Solution [Xyrem] (RxNorm concept RXCUI 352257, generic name sodium oxybate) appears on 8 distinct formulary files spanning 38 Medicare Part D plan offerings - 0.8% 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 sodium oxybate 500 MG/ML Oral Solution [Xyrem] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 87.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 855 Part D beneficiaries filled sodium oxybate 500 MG/ML Oral Solution [Xyrem] 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 500 MG/ML Oral Solution [Xyrem] today.
Coverage Details
- Formularies covering
- 8
- Plans covering
- 38
- Coverage rate
- 0.8%
- Tier range
- Tier 5, Specialty
- Average tier
- Tier 5, Specialty
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 87.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 855
- Total spending
- $98,471,849
- Avg per beneficiary
- $115,171.75
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering sodium oxybate 500 MG/ML Oral Solution [Xyrem]
38 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Presbyterian Senior Care Plan 2 with Rx (HMO) | Presbyterian Health Plan | T5 | Yes | $0 | NM |
| Presbyterian Dual Plus (HMO D-SNP) | Presbyterian Health Plan | T5 | Yes | $0 | NM |
| Presbyterian Senior Care Extra Health Plan with Rx (HMO) | Presbyterian Health Plan | T5 | Yes | $0 | NM |
| Prominence Plus (HMO) | Prominence Healthfirst | T5 | Yes | $0 | NV |
| Prominence Plus (HMO) | Prominence Healthfirst | T5 | Yes | $0 | NV |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst | T5 | Yes | $0 | NV |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst | T5 | Yes | $0 | NV |
| Prominence Giveback (HMO) | Prominence Healthfirst | T5 | Yes | $0 | NV |
| Prominence Plus (HMO) | Prominence Healthfirst OF Florida Inc | T5 | Yes | $0 | FL |
| Prominence Giveback (HMO) | Prominence Healthfirst OF Florida Inc | T5 | Yes | $0 | FL |
| Prominence Plus (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Plus (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Extra Help (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Beyond (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Giveback (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Giveback (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Beyond (HMO-POS) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst OF Florida Inc | T5 | Yes | $0 | FL |
Show the next 18 plans
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst | T5 | Yes | $0 | NV |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst OF Florida Inc | T5 | Yes | $0 | FL |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Diabetes and Heart Care Plus (HMO C-SNP) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| CareOregon Advantage Plus (HMO D-SNP) | Health Plan OF Careoregon, Inc. | T5 | Yes | $0 | OR |
| Prominence Extra Help (HMO) | Prominence Healthfirst | T5 | Yes | $4.20 | NV |
| Prominence Extra Help (HMO) | Prominence Healthfirst OF Florida Inc | T5 | Yes | $4.80 | FL |
| Prominence Extra Help (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $4.80 | TX |
| Prominence Extra Help (HMO) | Prominence Healthfirst | T5 | Yes | $9.50 | NV |
| Samaritan Dual Advantage (HMO D-SNP) | Samaritan Health Plans, Inc. | T5 | Yes | $10.50 | OR |
| Keystone 65 Select Rx (HMO) | Keystone Health Plan East, Inc. | T5 | Yes | $47.00 | PA |
| Keystone 65 Preferred Rx (HMO) | Keystone Health Plan East, Inc. | T5 | Yes | $59.70 | PA |
| Keystone 65 Select Rx (HMO) | Keystone Health Plan East, Inc. | T5 | Yes | $63.50 | PA |
| Presbyterian Senior Care Plan 3 with Rx (HMO) | Presbyterian Health Plan | T5 | Yes | $65.80 | NM |
| Keystone 65 Preferred Rx (HMO) | Keystone Health Plan East, Inc. | T5 | Yes | $79.70 | PA |
| Personal Choice 65 Rx (PPO) | QCC Insurance Company | T5 | Yes | $102.20 | PA |
| Personal Choice 65 Rx (PPO) | QCC Insurance Company | T5 | Yes | $112.70 | PA |
Frequently Asked Questions
Is sodium oxybate 500 MG/ML Oral Solution [Xyrem] covered by Medicare Part D?
Yes, sodium oxybate 500 MG/ML Oral Solution [Xyrem] is covered by 38 Medicare Part D plans (0.8% of all Part D formularies).
What tier is sodium oxybate 500 MG/ML Oral Solution [Xyrem] on Medicare Part D plans?
sodium oxybate 500 MG/ML Oral Solution [Xyrem] averages Tier 5 across Part D plans, ranging from Tier 5 to Tier 5.
Does sodium oxybate 500 MG/ML Oral Solution [Xyrem] require prior authorization?
100% of Part D formularies require prior authorization for sodium oxybate 500 MG/ML Oral Solution [Xyrem]. Step therapy: 0%. Quantity limits: 87.5%.
How much does Medicare spend on sodium oxybate 500 MG/ML Oral Solution [Xyrem]?
In 2023, total Medicare Part D spending on sodium oxybate 500 MG/ML Oral Solution [Xyrem] 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
- 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
- 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