tasimelteon 4 MG/ML Oral Suspension [Hetlioz]
tasimelteon
RxCUI: 2468316
What the CMS Formulary Data Shows for tasimelteon 4 MG/ML Oral Suspension [Hetlioz]
Per the CMS 2026 Part D formulary file, tasimelteon 4 MG/ML Oral Suspension [Hetlioz] (RxNorm concept RXCUI 2468316, generic name tasimelteon) appears on 34 distinct formulary files spanning 115 Medicare Part D plan offerings - 2.3% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.
Real-world access to tasimelteon 4 MG/ML Oral Suspension [Hetlioz] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 76.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 499 Part D beneficiaries filled tasimelteon 4 MG/ML Oral Suspension [Hetlioz] in 2023, with total plan-and-beneficiary spending of $95,952,401 and an average per-beneficiary annual cost of $192,289.38. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry tasimelteon 4 MG/ML Oral Suspension [Hetlioz] today.
Coverage Details
- Formularies covering
- 34
- Plans covering
- 115
- Coverage rate
- 2.3%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 76.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 499
- Total spending
- $95,952,401
- Avg per beneficiary
- $192,289.38
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering tasimelteon 4 MG/ML Oral Suspension [Hetlioz]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 | Yes | $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 |
| Mass General Brigham SCO (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | Yes | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | Yes | $0 | MA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | Yes | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | Yes | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK HEALTH OPTIONS WEST VIRGINIA INC. | T1 | Yes | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | Yes | $0 | DE |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T1 | Yes | $4.80 | FL |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | Yes | $13.10 | PA |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T1 | Yes | $17.00 | AZ |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | Yes | $17.60 | PA |
| Highmark Health Options Duals Select (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | Yes | $31.20 | DE |
| PHP (HMO C-SNP) | AIDS HEALTHCARE FOUNDATION | T4 | Yes | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS CHOICE | T4 | Yes | $0 | NY |
| Leon MediExtra (HMO) | LEON HEALTH, INC. | T4 | Yes | $0 | FL |
| Leon MediDual (HMO D-SNP) | LEON HEALTH, INC. | T4 | Yes | $0 | FL |
| Leon MediMore (HMO) | LEON HEALTH, INC. | T4 | Yes | $0 | FL |
| Leon MediMax (HMO D-SNP) | LEON HEALTH, INC. | T4 | Yes | $0 | FL |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS CHOICE | T4 | Yes | $51.60 | NY |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Flex (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Active (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Select Health Medicare Wellness (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Network Health Select (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T5 | Yes | $0 | WI |
| Network Health Go (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T5 | Yes | $0 | WI |
| Network Health Anywhere (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T5 | Yes | $0 | WI |
| Network Health Choice (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T5 | Yes | $0 | WI |
| Network Health Zero (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T5 | Yes | $0 | WI |
| Troy Medicare (HMO) | TROY HEALTH, INC. | T5 | Yes | $0 | NC |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | TROY HEALTH, INC. | T5 | Yes | $0 | NC |
| Contra Costa Health Care Plus (HMO D-SNP) | CONTRA COSTA COUNTY MEDICAL SERVICE DBA CONTRA COSTA HEALTH | T5 | Yes | $0 | CA |
| SummaCare Medicare Topaz (HMO) | SUMMACARE INC. | T5 | Yes | $0 | OH |
| SummaCare Medicare Quartz (HMO) | SUMMACARE INC. | T5 | Yes | $0 | OH |
Frequently Asked Questions
Is tasimelteon 4 MG/ML Oral Suspension [Hetlioz] covered by Medicare Part D?
Yes, tasimelteon 4 MG/ML Oral Suspension [Hetlioz] is covered by 115 Medicare Part D plans (2.3% of all Part D formularies).
What tier is tasimelteon 4 MG/ML Oral Suspension [Hetlioz] on Medicare Part D plans?
tasimelteon 4 MG/ML Oral Suspension [Hetlioz] averages Tier 4 across Part D plans, ranging from Tier 1 to Tier 5.
Does tasimelteon 4 MG/ML Oral Suspension [Hetlioz] require prior authorization?
100% of Part D formularies require prior authorization for tasimelteon 4 MG/ML Oral Suspension [Hetlioz]. Step therapy: 0%. Quantity limits: 76.5%.
How much does Medicare spend on tasimelteon 4 MG/ML Oral Suspension [Hetlioz]?
In 2023, total Medicare Part D spending on tasimelteon 4 MG/ML Oral Suspension [Hetlioz] was $95,952,401, covering 499 beneficiaries. The average spend per beneficiary was $192,289.38.
Read our methodology - how this data is sourced, computed, and verified.