Medicare Part D coverage · trofinetide · RxCUI 2729451
trofinetide 5000 MG Powder for Oral Solution [Daybue]
Per the CMS 2026 Part D formulary file, trofinetide 5000 MG Powder for Oral Solution [Daybue] is covered by 51 Medicare Part D plans (1% of enrollable products), averaging Tier 3.5, with prior authorization required on 100% of covering formularies.
- 1%
- Plan coverage
- 51
- Plans covering
- T3.5
- Avg tier
- 100%
- Prior auth required
What the CMS Formulary Data Shows for trofinetide 5000 MG Powder for Oral Solution [Daybue]
Per the CMS 2026 Part D formulary file, trofinetide 5000 MG Powder for Oral Solution [Daybue] (RxNorm concept RXCUI 2729451, generic name trofinetide) appears on 10 distinct formulary files spanning 51 Medicare Part D plan offerings - 1% 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 3.5.
Real-world access to trofinetide 5000 MG Powder for Oral Solution [Daybue] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 90% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 94 Part D beneficiaries filled trofinetide 5000 MG Powder for Oral Solution [Daybue] in 2023, with total plan-and-beneficiary spending of $19,168,240 and an average per-beneficiary annual cost of $203,917.44. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry trofinetide 5000 MG Powder for Oral Solution [Daybue] today.
Coverage Details
- Formularies covering
- 10
- Plans covering
- 51
- Coverage rate
- 1%
- 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
- 90% of formularies
2023 Medicare Spending
- Beneficiaries
- 94
- Total spending
- $19,168,240
- Avg per beneficiary
- $203,917.44
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering trofinetide 5000 MG Powder for Oral Solution [Daybue]
51 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $13.10 | PA |
| 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 |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T2 | Yes | $0 | CA |
| Medicare BlueEssential (PPO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Medicare BlueActive (PPO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Medicare BlueVital (PPO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Univera SeniorChoice Basic (HMO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Univera SeniorChoice Extra (HMO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Medicare Blue Choice Core (HMO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Health First Rewards H1099-014 (HMO) | Health First Health Plans | T5 | Yes | $0 | FL |
| Health First SunSaver H1099-016 (HMO) | Health First Health Plans | T5 | Yes | $0 | FL |
| Health First Complete Care H1099-023 (HMO) | Health First Health Plans | T5 | Yes | $0 | FL |
| Health First Emerald Plus H1099-024 (HMO) | Health First Health Plans | T5 | Yes | $0 | FL |
Show the next 30 plans
| Health First Premier Access H1099-025 (HMO-POS) | Health First Health Plans | T5 | Yes | $0 | FL |
| Health First Emerald Plus H1099-026 (HMO) | Health First Health Plans | T5 | Yes | $0 | FL |
| Health First Premier Access H1099-027 (HMO-POS) | Health First Health Plans | T5 | Yes | $0 | FL |
| Health First Emerald Plus H1099-028 (HMO) | Health First Health Plans | T5 | Yes | $0 | FL |
| CDPHP $0 Medicare Rx (HMO) | Capital District Physicians' Health Plan, Inc. | T5 | Yes | $0 | NY |
| Mass General Brigham Advantage (PPO) | Mass General Brigham Health Plan, Inc. | T5 | Yes | $0 | MA |
| UPMC for Life HMO Rx Choice (HMO) | Upmc Health Plan, Inc. | T5 | Yes | $3.90 | OH, PA |
| Health First Value H1099-006 (HMO) | Health First Health Plans | T5 | Yes | $15.00 | FL |
| UPMC for Life HMO Deductible Rx (HMO) | Upmc Health Plan, Inc. | T5 | Yes | $18.10 | OH, PA |
| UPMC for Life PPO Rx Choice (PPO) | Upmc Health Network, Inc. | T5 | Yes | $25.00 | PA |
| Univera SeniorChoice Core (PPO) | Excellus Health Plan, Inc. | T5 | Yes | $33.00 | NY |
| UPMC for Life PPO High Deductible Rx (PPO) | Upmc Health Network, Inc. | T5 | Yes | $33.00 | PA |
| UPMC for Life HMO Rx (HMO) | Upmc Health Plan, Inc. | T5 | Yes | $33.70 | OH, PA |
| Univera SeniorChoice Advanced (HMO-POS) | Excellus Health Plan, Inc. | T5 | Yes | $36.90 | NY |
| UPMC for Life PPO Rx Enhanced (PPO) | Upmc Health Network, Inc. | T5 | Yes | $42.70 | PA |
| Health First Classic H1099-001 (HMO-POS) | Health First Health Plans | T5 | Yes | $49.40 | FL |
| Medicare BlueClassic (PPO) | Excellus Health Plan, Inc. | T5 | Yes | $51.00 | NY |
| Univera SeniorChoice Secure (HMO-POS) | Excellus Health Plan, Inc. | T5 | Yes | $54.90 | NY |
| Medicare BlueBalanced (PPO) | Excellus Health Plan, Inc. | T5 | Yes | $55.00 | NY |
| Medicare Blue Choice Prime (HMO) | Excellus Health Plan, Inc. | T5 | Yes | $55.00 | NY |
| Univera SeniorChoice Value Plus (HMO-POS) | Excellus Health Plan, Inc. | T5 | Yes | $58.60 | NY |
| Mass General Brigham Advantage Secure (HMO-POS) | Mass General Brigham Health Plan, Inc. | T5 | Yes | $62.00 | MA |
| Medicare BlueEnhanced (PPO) | Excellus Health Plan, Inc. | T5 | Yes | $70.30 | NY |
| Mass General Brigham Advantage Premier (PPO) | Mass General Brigham Health Plan, Inc. | T5 | Yes | $79.70 | MA |
| Medicare BluePlus (PPO) | Excellus Health Plan, Inc. | T5 | Yes | $86.40 | NY |
| UPMC for Life HMO Rx Enhanced (HMO) | Upmc Health Plan, Inc. | T5 | Yes | $93.40 | OH, PA |
| CDPHP Clear Rx (HMO) | Capital District Physicians' Health Plan, Inc. | T5 | Yes | $100.00 | NY |
| CDPHP Choice Rx (HMO) | Capital District Physicians' Health Plan, Inc. | T5 | Yes | $135.00 | NY |
| UPMC for Life PPO Rx Enhanced (PPO) | Upmc Health Network, Inc. | T5 | Yes | $140.00 | PA |
| Medicare Blue Choice Optimum (HMO-POS) | Excellus Health Plan, Inc. | T5 | Yes | $146.00 | NY |
Showing top 50 of 51 plans.
Frequently Asked Questions
Is trofinetide 5000 MG Powder for Oral Solution [Daybue] covered by Medicare Part D?
Yes, trofinetide 5000 MG Powder for Oral Solution [Daybue] is covered by 51 Medicare Part D plans (1% of all Part D formularies).
What tier is trofinetide 5000 MG Powder for Oral Solution [Daybue] on Medicare Part D plans?
trofinetide 5000 MG Powder for Oral Solution [Daybue] averages Tier 3.5 across Part D plans, ranging from Tier 1 to Tier 5.
Does trofinetide 5000 MG Powder for Oral Solution [Daybue] require prior authorization?
100% of Part D formularies require prior authorization for trofinetide 5000 MG Powder for Oral Solution [Daybue]. Step therapy: 0%. Quantity limits: 90%.
How much does Medicare spend on trofinetide 5000 MG Powder for Oral Solution [Daybue]?
In 2023, total Medicare Part D spending on trofinetide 5000 MG Powder for Oral Solution [Daybue] was $19,168,240, covering 94 beneficiaries. The average spend per beneficiary was $203,917.44.
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
- lomustine 40 MG Oral Capsule T3.5
- 1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia] T3.5
- tretinoin 0.001 MG/MG Topical Gel T3.5
- ethacrynic acid 25 MG Oral Tablet T3.5
- daridorexant 25 MG Oral Tablet [Quviviq] T3.5
- 24 HR canagliflozin 150 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Invokamet] T3.5
Similar prior-authorization rate
- sodium phenylbutyrate 0.483 MG/MG Oral Pellet [Pheburane] 100% PA
- azathioprine 50 MG Oral Tablet 100% PA
- formoterol fumarate 0.01 MG/ML Inhalation Solution [Perforomist] 100% PA
- lusutrombopag 3 MG Oral Tablet [Mulpleta] 100% PA
- 12 HR tapentadol 100 MG Extended Release Oral Tablet [Nucynta] 100% PA
- {14 (24 HR lamotrigine 100 MG Extended Release Oral Tablet [Lamictal]) / 7 (24 HR lamotrigine 200 MG Extended Release Oral Tablet [Lamictal]) / 14 (24 HR lamotrigine 50 MG Extended Release Oral Tablet [Lamictal]) } Pack [Lamictal XR Green Patient Titration Kit (for Patients Taking Carbamazepine, Phenytoin, Phenobarbital, or Primidone, and Not Taking Valproate)] 100% PA