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Clozapine 25 mg/1 Medicare Part D Coverage

Dosage form
TABLET, ORALLY DISINTEGRATING
Route
ORAL
Drug class
Antipsychotics
100%
of Medicare Part D plans
cover Clozapine
5,529 of 5,530 plans
3.7
Avg. formulary tier
$12.00
Median 30-day copay
$0.00–$24.00
Copay range

Formulary Tier Distribution

How Medicare Part D plans classify Clozapine. Lower tiers = lower copays.

Tier 1 - Preferred Generic 3%
173 plans • avg $0.00/mo
Tier 2 - Generic 10%
546 plans • avg $2.88/mo
Tier 3 - Preferred Brand 1%
44 plans • avg $7.50/mo
Tier 4 - Non-Preferred Drug 86%
4,766 plans • avg $4.32/mo

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Clozapine Medicare Coverage by State

Coverage rates and average costs vary significantly by state. Click a state to see the specific plans available there.

Alabama 100% Arizona 100% Arkansas 100% California 100% Colorado 100% Connecticut 100% Delaware 100% District of Columbia 100% Florida 100% avg $1.88 Georgia 100% Hawaii 100% Idaho 100% Illinois 100% Indiana 100% Iowa 100% Kansas 100% Kentucky 100% Louisiana 100% Maine 100% avg $3.13 Maryland 100% avg $2.18 Massachusetts 100% avg $12.40 Michigan 100% avg $12.49 Minnesota 100% Mississippi 100% Missouri 100% Montana 100% Nebraska 100% Nevada 100% New Hampshire 100% New Jersey 100% New Mexico 100% New York 100% North Carolina 100% North Dakota 100% Ohio 100% Oklahoma 100% Oregon 100% avg $1.33 Pennsylvania 100% Puerto Rico 100% Rhode Island 100% South Carolina 100% South Dakota 100% Tennessee 100% Texas 100% Utah 100% Vermont 100% Virginia 100% Washington 100% avg $20.00 West Virginia 100% Wisconsin 100% Wyoming 100%

Alternative Medications in the Same Drug Class

Other drugs in the Antipsychotics that Medicare Part D plans also cover.

Haloperidol Avg Tier 2.0 $15.00/mo 5,529 plans Haloperidol Avg Tier 2.1 $15.00/mo 5,529 plans Clozapine Avg Tier 3.7 $12.00/mo 5,529 plans Risperidone Avg Tier 4.8 $0.00/mo 5,529 plans Haloperidol Avg Tier 2.1 $15.00/mo 5,529 plans Haloperidol Avg Tier 2.3 $15.00/mo 5,529 plans Olanzapine Avg Tier 3.6 $12.00/mo 5,529 plans Risperidone Avg Tier 4.5 $0.00/mo 5,529 plans

Related Versions of Clozapine

Clozapine 150 mg/1 Brand Clozapine 200 mg/1 Brand Clozapine 12.5 mg/1 Brand Clozapine 100 mg/1 Brand

Frequently Asked Questions about Clozapine

100% of Medicare Part D plans cover Clozapine. It is most commonly placed on Tier 4. Coverage varies by plan and geographic area.

The median 30-day copay for Clozapine on Medicare Part D is $12.00 at a preferred pharmacy. Costs range from $0.00 to $24.00 depending on the plan.

Clozapine is placed on Tier 4 by most Medicare Part D plans. Lower tier numbers generally mean lower copays.

0% of plans require prior authorization for Clozapine. Prior authorization means your doctor must confirm the drug is medically necessary before the plan will cover it.

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Coverage statistics based on CMS formulary data for plan year 2026. Data updated regularly. Methodology →