Medicare Part D coverage · valbenazine · RxCUI 1986331
valbenazine 80 MG Oral Capsule [Ingrezza]
Per the CMS 2026 Part D formulary file, valbenazine 80 MG Oral Capsule [Ingrezza] is covered by 2,438 Medicare Part D plans (48.3% of enrollable products), averaging Tier 4.1, with prior authorization required on 99.5% of covering formularies.
- 48.3%
- Plan coverage
- 2,438
- Plans covering
- T4.1
- Avg tier
- 99.5%
- Prior auth required
What the CMS Formulary Data Shows for valbenazine 80 MG Oral Capsule [Ingrezza]
Per the CMS 2026 Part D formulary file, valbenazine 80 MG Oral Capsule [Ingrezza] (RxNorm concept RXCUI 1986331, generic name valbenazine) appears on 206 distinct formulary files spanning 2,438 Medicare Part D plan offerings - 48.3% 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 4.1.
Real-world access to valbenazine 80 MG Oral Capsule [Ingrezza] depends on utilization management as much as tier placement: 99.5% of covering formularies require prior authorization. 0% require step therapy. 95.1% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 29,191 Part D beneficiaries filled valbenazine 80 MG Oral Capsule [Ingrezza] in 2023, with total plan-and-beneficiary spending of $1,705,132,723 and an average per-beneficiary annual cost of $58,412.96. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry valbenazine 80 MG Oral Capsule [Ingrezza] today.
Coverage Details
- Formularies covering
- 206
- Plans covering
- 2,438
- Coverage rate
- 48.3%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 99.5% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 95.1% of formularies
2023 Medicare Spending
- Beneficiaries
- 29,191
- Total spending
- $1,705,132,723
- Avg per beneficiary
- $58,412.96
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering valbenazine 80 MG Oral Capsule [Ingrezza]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | Yes | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | Yes | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | Yes | $0 | NJ |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | Yes | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | Yes | $0 | GA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | Yes | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | Yes | $0 | AL |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | Yes | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| 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 |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | Yes | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | Yes | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
Show the next 30 plans
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $0 | NY |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | Yes | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | Yes | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $0 | MO |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $0 | AR |
| 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 |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | Yes | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | American Health Plan OF FL, Inc. | T1 | Yes | $4.80 | FL |
| SECUR Advantage (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| SECUR Enhanced (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Hcsc Insurance Services Company | T1 | Yes | $4.80 | TX |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | Yes | $4.80 | TX |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS Insurance Company | T1 | Yes | $5.00 | OK |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | Yes | $8.80 | MI |
| Senior Care (HMO I-SNP) | Align Senior Care MI, LLC | T1 | Yes | $8.80 | MI |
| Tribute Select (HMO-POS I-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $8.90 | AR |
| AgeRight Advantage Health Plan (HMO I-SNP) | Marquis Advantage, Inc. | T1 | Yes | $10.50 | OR, WA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is valbenazine 80 MG Oral Capsule [Ingrezza] covered by Medicare Part D?
Yes, valbenazine 80 MG Oral Capsule [Ingrezza] is covered by 2,438 Medicare Part D plans (48.3% of all Part D formularies).
What tier is valbenazine 80 MG Oral Capsule [Ingrezza] on Medicare Part D plans?
valbenazine 80 MG Oral Capsule [Ingrezza] averages Tier 4.1 across Part D plans, ranging from Tier 1 to Tier 5.
Does valbenazine 80 MG Oral Capsule [Ingrezza] require prior authorization?
99.5% of Part D formularies require prior authorization for valbenazine 80 MG Oral Capsule [Ingrezza]. Step therapy: 0%. Quantity limits: 95.1%.
How much does Medicare spend on valbenazine 80 MG Oral Capsule [Ingrezza]?
In 2023, total Medicare Part D spending on valbenazine 80 MG Oral Capsule [Ingrezza] was $1,705,132,723, covering 29,191 beneficiaries. The average spend per beneficiary was $58,412.96.
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
- brivaracetam 10 MG Oral Tablet [Briviact] T4.1
- rifaximin 550 MG Oral Tablet [XIFAXAN] T4.1
- tenofovir disoproxil fumarate 200 MG Oral Tablet [Viread] T4.1
- pomalidomide 1 MG Oral Capsule T4.1
- 1 ML benralizumab 30 MG/ML Prefilled Syringe [Fasenra] T4.1
- deferasirox 250 MG Tablet for Oral Suspension T4.1
Similar prior-authorization rate
- pirfenidone 534 MG Oral Tablet 99.5% PA
- avatrombopag 20 MG Oral Tablet [Doptelet] 99.5% PA
- {10 (avatrombopag 20 MG Oral Tablet [Doptelet]) } Pack [Doptelet 40 MG Daily Dose Carton] 99.5% PA
- {15 (avatrombopag 20 MG Oral Tablet [Doptelet]) } Pack [Doptelet 60 MG Daily Dose Carton] 99.5% PA
- {7 (valbenazine 40 MG Oral Capsule [Ingrezza]) / 21 (valbenazine 80 MG Oral Capsule [Ingrezza]) } Pack [Ingrezza] 99.5% PA
- granisetron 1 MG Oral Tablet 99.6% PA