tetrabenazine 25 MG Oral Tablet [Xenazine]
tetrabenazine
RxCUI: 805462
What the CMS Formulary Data Shows for tetrabenazine 25 MG Oral Tablet [Xenazine]
Per the CMS 2026 Part D formulary file, tetrabenazine 25 MG Oral Tablet [Xenazine] (RxNorm concept RXCUI 805462, generic name tetrabenazine) appears on 2 distinct formulary files spanning 8 Medicare Part D plan offerings - 0.2% 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 3.
Real-world access to tetrabenazine 25 MG Oral Tablet [Xenazine] depends on utilization management as much as tier placement: 50% of covering formularies require prior authorization. 0% require step therapy. 50% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 3,523 Part D beneficiaries filled tetrabenazine 25 MG Oral Tablet [Xenazine] in 2023, with total plan-and-beneficiary spending of $58,876,344 and an average per-beneficiary annual cost of $16,711.99. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry tetrabenazine 25 MG Oral Tablet [Xenazine] today.
Coverage Details
- Formularies covering
- 2
- Plans covering
- 8
- Coverage rate
- 0.2%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 50% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 50% of formularies
2023 Medicare Spending
- Beneficiaries
- 3,523
- Total spending
- $58,876,344
- Avg per beneficiary
- $16,711.99
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering tetrabenazine 25 MG Oral Tablet [Xenazine]
8 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $0 | NY |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $34.50 | NY |
| Óptimo Plus (PPO) | TRIPLE S ADVANTAGE, INC. | T5 | No | $0 | PR |
| Contigo Plus (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T5 | No | $0 | PR |
| Brillante (HMO-POS) | TRIPLE S ADVANTAGE, INC. | T5 | No | $0 | PR |
| Enlace Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T5 | No | $0 | PR |
| ContigoEnMente (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T5 | No | $0 | PR |
| Ahorro Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T5 | No | $0 | PR |
Frequently Asked Questions
Is tetrabenazine 25 MG Oral Tablet [Xenazine] covered by Medicare Part D?
Yes, tetrabenazine 25 MG Oral Tablet [Xenazine] is covered by 8 Medicare Part D plans (0.2% of all Part D formularies).
What tier is tetrabenazine 25 MG Oral Tablet [Xenazine] on Medicare Part D plans?
tetrabenazine 25 MG Oral Tablet [Xenazine] averages Tier 3 across Part D plans, ranging from Tier 1 to Tier 5.
Does tetrabenazine 25 MG Oral Tablet [Xenazine] require prior authorization?
50% of Part D formularies require prior authorization for tetrabenazine 25 MG Oral Tablet [Xenazine]. Step therapy: 0%. Quantity limits: 50%.
How much does Medicare spend on tetrabenazine 25 MG Oral Tablet [Xenazine]?
In 2023, total Medicare Part D spending on tetrabenazine 25 MG Oral Tablet [Xenazine] was $58,876,344, covering 3,523 beneficiaries. The average spend per beneficiary was $16,711.99.
Read our methodology - how this data is sourced, computed, and verified.