trofinetide 200 MG/ML Oral Solution [Daybue]
trofinetide
RxCUI: 2632863
What the CMS Formulary Data Shows for trofinetide 200 MG/ML Oral Solution [Daybue]
Per the CMS 2026 Part D formulary file, trofinetide 200 MG/ML Oral Solution [Daybue] (RxNorm concept RXCUI 2632863, generic name trofinetide) appears on 19 distinct formulary files spanning 231 Medicare Part D plan offerings - 4.6% 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 4.3.
Real-world access to trofinetide 200 MG/ML Oral Solution [Daybue] depends on utilization management as much as tier placement: 94.7% of covering formularies require prior authorization. 0% require step therapy. 73.7% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 94 Part D beneficiaries filled trofinetide 200 MG/ML 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 200 MG/ML Oral Solution [Daybue] today.
Coverage Details
- Formularies covering
- 19
- Plans covering
- 231
- Coverage rate
- 4.6%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 94.7% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 73.7% 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 200 MG/ML Oral Solution [Daybue]
100 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 |
| HAP Medicare Explore (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T5 | Yes | $0 | MI |
| HAP Medicare Prime (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T5 | Yes | $0 | MI |
| HAP Medicare Connect (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T5 | Yes | $0 | MI |
| HAP Medicare Complete Duals (HMO D-SNP) | HEALTH ALLIANCE PLAN OF MICHIGAN | T5 | Yes | $0 | MI |
| HAP Medicare Superior (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T5 | Yes | $0 | MI |
| Henry Ford Select (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T5 | Yes | $0 | MI |
| Geisinger Gold Preferred Complete Rx (PPO) | GEISINGER INDEMNITY INSURANCE COMPANY | T5 | Yes | $0 | PA |
| Geisinger Gold Secure Rx (HMO D-SNP) | GEISINGER HEALTH PLAN | T5 | Yes | $0 | PA |
| Geisinger Gold Classic 360 Rx (HMO) | GEISINGER HEALTH PLAN | T5 | Yes | $0 | PA |
| Geisinger Gold Classic Essential Rx (HMO) | GEISINGER HEALTH PLAN | T5 | Yes | $0 | PA |
| MCS Classicare RxMax (HMO) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Platino Ideal (HMO D-SNP) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Efectivo (HMO) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Essential (HMO-POS) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Platino Progreso (HMO D-SNP) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Primero (HMO C-SNP) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Firme (HMO) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare En Tu Hogar (HMO) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Hero (HMO) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Platino Total (HMO D-SNP) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare InteliCare (HMO) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Platino Maximo (HMO D-SNP) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Excede (HMO) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Estrella (HMO) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Platino Superior (HMO D-SNP) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Platino 185 (HMO D-SNP) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| 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 |
| 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 |
Frequently Asked Questions
Is trofinetide 200 MG/ML Oral Solution [Daybue] covered by Medicare Part D?
Yes, trofinetide 200 MG/ML Oral Solution [Daybue] is covered by 231 Medicare Part D plans (4.6% of all Part D formularies).
What tier is trofinetide 200 MG/ML Oral Solution [Daybue] on Medicare Part D plans?
trofinetide 200 MG/ML Oral Solution [Daybue] averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 6.
Does trofinetide 200 MG/ML Oral Solution [Daybue] require prior authorization?
94.7% of Part D formularies require prior authorization for trofinetide 200 MG/ML Oral Solution [Daybue]. Step therapy: 0%. Quantity limits: 73.7%.
How much does Medicare spend on trofinetide 200 MG/ML Oral Solution [Daybue]?
In 2023, total Medicare Part D spending on trofinetide 200 MG/ML 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.