Medicare Part D coverage · trofinetide · RxCUI 2632863
trofinetide 200 MG/ML Oral Solution [Daybue]
Per the CMS 2026 Part D formulary file, trofinetide 200 MG/ML Oral Solution [Daybue] is covered by 230 Medicare Part D plans (4.6% of enrollable products), averaging Tier 4.3, with prior authorization required on 94.7% of covering formularies.
- 4.6%
- Plan coverage
- 230
- Plans covering
- T4.3
- Avg tier
- 94.7%
- Prior auth required
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 230 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
- 230
- 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 |
Show the next 30 plans
| 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 |
Showing top 50 of 100 plans.
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 230 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.
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
- ceftaroline fosamil 400 MG Injection T4.3
- lomustine 100 MG Oral Capsule [Gleostine] T4.3
- 0.67 ML anakinra 149 MG/ML Prefilled Syringe [Kineret] T4.3
- sofosbuvir 400 MG / velpatasvir 100 MG Oral Tablet [Epclusa] T4.3
- 0.25 ML somatropin 4.8 MG/ML Prefilled Syringe [Genotropin] T4.3
- olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi] T4.3
Similar prior-authorization rate
- seladelpar 10 MG Oral Capsule [Livdelzi] 94.6% PA
- sapropterin dihydrochloride 100 MG Oral Tablet 94.6% PA
- deferasirox 90 MG Oral Granules 94.6% PA
- deferasirox 360 MG Oral Granules 94.6% PA
- modafinil 200 MG Oral Tablet 94.5% PA
- aztreonam 75 MG/ML Inhalation Solution [Cayston] 94.5% PA