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Nexlizet is a brand of bempedoic acid / ezetimibe. What agents check before quoting it: how many 2026 Part D plans cover it, on which tier, with what restrictions and copays, by plan type, carrier and state.
In 2026, 4,923 of 5,496 Medicare Part D and Medicare Advantage drug plans (89.6%) list Nexlizet on their formulary, across 300 of 328 formularies. The most common placement is tier 3 (4,263 plans, 86.6% of those covering it). 3,324 of the covering plans require prior authorization (67.5%), 183 step therapy and 4,579 a quantity limit.
1,527 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $47, 93 of them $0; 3,396 charge coinsurance instead — median 24% of the drug's cost. Once a member's out-of-pocket drug spending reaches $2,100 in 2026, covered drugs cost $0 for the rest of the year.
2025: 3,528 of 5,631 plans covered it (62.7%); 2026: 4,923 of 5,496 (89.6%).
Of 4,368 plans offered in both years, 1,277 added it to the formulary and 72 dropped it.
Among plans covering it both years, 36 moved it to a higher tier and 20 to a lower one; 44 added prior authorization and 15 removed it.
Medicare Part D paid for 181,104 30-day fills of Nexlizet in 2024 for about 27,136 enrollees, at an average total cost of $390.26 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Nexlizet and the rest of a client's list on every plan in their county.
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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 09/16/2026). CMS formulary data.