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Mexiletine is a generic drug. What agents check before quoting it: how many 2027 Part D plans cover it, on which tier, with what restrictions and copays, by plan type, carrier and state.
In 2027, 2,702 of 5,492 Medicare Part D and Medicare Advantage drug plans (49.2%) list Mexiletine on their formulary, across 160 of 286 formularies. The most common placement is tier 3 (1,493 plans, 55.3% of those covering it). 0 of the covering plans require prior authorization (0%), 0 step therapy and 0 a quantity limit.
977 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $0, 540 of them $0; 1,725 charge coinsurance instead — median 25% of the drug's cost. Once a member's out-of-pocket drug spending reaches $2,400 in 2027, covered drugs cost $0 for the rest of the year.
2026: 2,964 of 5,496 plans covered it (53.9%); 2027: 2,702 of 5,492 (49.2%).
Of 4,367 plans offered in both years, 25 added it to the formulary and 30 dropped it.
Among plans covering it both years, 96 moved it to a higher tier and 276 to a lower one; 0 added prior authorization and 0 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 135 |
| Tier 2 | 835 |
| Tier 3 | 1,493 |
| Tier 4 | 239 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 119 of 323 | 36.8% | 0% |
| Medicare Advantage with drugs (MA-PD) | 1,559 of 3,200 | 48.7% | 0% |
| Special needs plans (SNP) | 1,024 of 1,969 | 52% | 0% |
| Carrier | Plans covering | Usual tier | Prior auth |
|---|---|---|---|
| Humana | 0 of 846 | No tier listed | 0 |
| UnitedHealthcare | 830 of 830 | Tier 3 | 0 |
| Devoted Health | 0 of 728 | No tier listed | 0 |
| Aetna Medicare | 0 of 631 | No tier listed | 0 |
| Wellcare | 200 of 268 | Tier 3 | 0 |
| HealthSpring | 226 of 226 | Tier 2 | 0 |
| Kaiser Permanente | 112 of 112 | Tier 2 | 0 |
| SCAN Health Plan | 83 of 83 | Tier 2 | 0 |
| Highmark Blue Cross Blue Shield or Highmark Blue Shield | 80 of 80 | Tier 3 | 0 |
| Alignment Health Plan | 77 of 77 | Tier 3 | 0 |
| Anthem Blue Cross and Blue Shield | 74 of 74 | Tier 2 | 0 |
| Wellpoint | 63 of 63 | Tier 2 | 0 |
| Priority Health Medicare | 40 of 40 | Tier 4 | 0 |
| CarePlus Health Plans, Inc. | 0 of 37 | No tier listed | 0 |
| Zing Health | 0 of 36 | No tier listed | 0 |
| Capital Blue Cross | 35 of 35 | Tier 3 | 0 |
| Prominence Health Plan | 29 of 29 | Tier 2 | 0 |
| Medica | 27 of 27 | Tier 3 | 0 |
| Anthem HealthKeepers | 26 of 26 | Tier 2 | 0 |
| Blue Cross Blue Shield of Michigan | 0 of 26 | No tier listed | 0 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 39 of 114 | 34.2% |
| Alaska | 3 of 9 | 33.3% |
| American Samoa | 1 of 1 | 100% |
| Arizona | 75 of 147 | 51% |
| Arkansas | 30 of 85 | 35.3% |
| California | 285 of 397 | 71.8% |
| Colorado | 53 of 106 | 50% |
| Connecticut | 20 of 54 | 37% |
| Delaware | 23 of 43 | 53.5% |
| District of Columbia | 8 of 12 | 66.7% |
| Florida | 214 of 545 | 39.3% |
| Georgia | 73 of 149 | 49% |
| Guam | 1 of 1 | 100% |
| Hawaii | 16 of 50 | 32% |
| Idaho | 18 of 45 | 40% |
| Illinois | 49 of 132 | 37.1% |
| Indiana | 58 of 138 | 42% |
| Iowa | 31 of 64 | 48.4% |
| Kansas | 27 of 84 | 32.1% |
| Kentucky | 49 of 121 | 40.5% |
| Louisiana | 52 of 125 | 41.6% |
| Maine | 22 of 52 | 42.3% |
| Maryland | 22 of 49 | 44.9% |
| Massachusetts | 58 of 89 | 65.2% |
| Michigan | 79 of 182 | 43.4% |
| Minnesota | 38 of 63 | 60.3% |
| Mississippi | 49 of 104 | 47.1% |
| Missouri | 60 of 170 | 35.3% |
| Montana | 5 of 27 | 18.5% |
| Nebraska | 20 of 51 | 39.2% |
| Nevada | 59 of 100 | 59% |
| New Hampshire | 8 of 25 | 32% |
| New Jersey | 33 of 73 | 45.2% |
| New Mexico | 39 of 68 | 57.4% |
| New York | 97 of 215 | 45.1% |
| North Carolina | 86 of 176 | 48.9% |
| North Dakota | 17 of 26 | 65.4% |
| Northern Mariana Islands | 1 of 1 | 100% |
| Ohio | 89 of 171 | 52% |
| Oklahoma | 31 of 81 | 38.3% |
| Oregon | 36 of 92 | 39.1% |
| Pennsylvania | 209 of 323 | 64.7% |
| Puerto Rico | 64 of 64 | 100% |
| Rhode Island | 12 of 29 | 41.4% |
| South Carolina | 40 of 89 | 44.9% |
| South Dakota | 17 of 30 | 56.7% |
| Tennessee | 51 of 156 | 32.7% |
| Texas | 215 of 407 | 52.8% |
| U.S. Virgin Islands | 1 of 1 | 100% |
| Utah | 22 of 53 | 41.5% |
| Vermont | 3 of 14 | 21.4% |
| Virginia | 66 of 144 | 45.8% |
| Washington | 62 of 114 | 54.4% |
| West Virginia | 37 of 69 | 53.6% |
| Wisconsin | 64 of 96 | 66.7% |
| Wyoming | 3 of 13 | 23.1% |
Medicare Part D paid for 174,303 30-day fills of Mexiletine in 2024 for about 23,298 enrollees, at an average total cost of $53.58 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Mexiletine and the rest of a client's list on every plan in their county.
Estimate Mexiletine costs by plan
Free tools for licensed insurance agents. Data from CMS public files; verify with plan documents before advising a client.
Counts are over every Medicare Advantage drug plan and stand-alone Part D plan in the CMS monthly formulary files, excluding employer plans. A plan counts as covering a drug when any strength or form of it is on the plan’s formulary; the tier, prior authorization, step therapy and quantity limit shown are the most favorable version on that formulary. Copays are for a 30-day supply at a preferred retail pharmacy after the deductible. This is a reference for licensed agents, not a plan recommendation; verify with the plan’s formulary before advising a client. Source: CMS Part D formulary files (release 10/08/2026). CMS formulary data.