Nuplazid (pimavanserin) is a brand-name medication that healthcare professionals often prescribe to help manage delusions or hallucinations with Parkinson’s disease.
Prescription drug plans (PDP) through Medicare Part D cover many prescription drugs. The cost is based on the type of medication and whether it is name-brand or generic.
Medicare Part D plans are extra plans a person with Original Medicare (Part A and Part B) can purchase. They are provided by private insurance companies. Each company also provides a list of covered prescriptions (formulary).
According to Nuplazid’s website, the wholesale cost for a 30-count bottle of the medication is $4,995.
The amount an individual pays out-of-pocket for the medication depends on the PDP plan and what tier Nuplazid falls into.
For example, since Nuplazid is a brand-name drug, it will most likely fall into tier 2. This means that it is likely to have a medium copayment.
In 2025, no Part D plan can have a deductible of more than $590.
Through 2024, when individuals reach $5,030 in out-of-pocket expenses, they enter the coverage gap or donut hole. When the coverage gap (also called the donut hole) is reached, a person will pay no more than 25% for prescriptions. Once they reach $8,000 in out-of-pocket expenses, they enter catastrophic coverage and no longer have to pay anything for prescription drugs for the rest of the year.
Not everyone will enter the donut hole.
Donut hole changes for 2025
As of January 1, 2025, all Medicare Part D plans will have an out-of-pocket expense cap of $2,000. Once this is reached, individuals will automatically enter catastrophic coverage and no longer have to pay anything for prescription drugs for the rest of the calendar year.
There are various ways a person can find help paying for prescription drugs:
- apply for Extra Help
- try to switch to generic drugs if possible
- look at pharmaceutical assistance programs
- look for a state pharmaceutical assistance program
In 2025, Medicare will also offer a prescription payment plan that allows individuals to spread their out-of-pocket prescription costs across the calendar year.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
