Medications
Dolutegravir (Tivicay)
An HIV integrase-blocker tablet (and a dispersible tablet for children) taken once or twice a day with other HIV medicines to treat HIV infection.
How Medicare covers it
Part D (forms used at home). Part A during a covered inpatient stay. No Part B clinician-administered form in the CMS Part B spending file.
| Coverage details | |
|---|---|
| Part B status | No dolutegravir row in the CMS Part B Spending by Drug HCPCS file (RY26, data through 2024) — no J-code basis; coverage path is Part D. |
| Medicare Advantage | Most Medicare Advantage plans that include drug coverage (MAPD plans) use the same formulary-and-tier system; the plan's own drug list decides coverage and copay — check the plan's formulary. |
| Medicare Supplement (Medigap) | Medicare Supplement (Medigap) plans sold today do not include prescription drug coverage; drug coverage comes from Part D or an MAPD plan. |
What it treats
Dolutegravir (Tivicay and Tivicay PD) is used with other antiretroviral medicines to treat HIV-1 infection in adults who have never been treated or who have been treated before, and in children who have never been treated or who have been treated before but have not taken an integrase strand transfer inhibitor (INSTI) before, weighing at least 2 kg. Tivicay is also used with rilpivirine as a complete regimen to treat HIV-1 infection in adults, to replace the current antiretroviral regimen in those whose virus is suppressed (HIV-1 RNA less than 50 copies per mL) on a stable regimen for at least 6 months, with no history of treatment failure and no known substitutions linked to resistance to either drug.
What it is for, in depth
Dolutegravir is an HIV-1 treatment medicine that is always used as part of combination antiretroviral therapy, except for the specific adult switch use with rilpivirine as a complete two-drug regimen in people whose virus is already suppressed on a stable regimen for at least 6 months with no history of treatment failure or known resistance substitutions for either drug. It is prescribed for adults who are treatment-naive or treatment-experienced, and for children weighing at least 2 kg who are treatment-naive or treatment-experienced but INSTI-naive. The pinned label covers both Tivicay film-coated tablets in 10 mg, 25 mg, and 50 mg strengths and Tivicay PD 5 mg tablets for oral suspension for young children, with weight-based dosing for children. The two forms are not bioequivalent and cannot be substituted milligram for milligram.
How it works
Dolutegravir is an HIV-1 antiretroviral medicine and an HIV integrase strand transfer inhibitor (INSTI). The label extract does not give a fuller step-by-step explanation of its mechanism beyond naming this class, so no further detail is given here.
How it is taken
It is taken by mouth, with or without food. For most adults, the dose is 50 mg once a day. The dose is 50 mg twice a day when it is taken with certain UGT1A or CYP3A inducer drugs, and for adults who have taken an INSTI before and have certain INSTI resistance substitutions or suspected INSTI resistance. Children's doses are based on body weight and age, using Tivicay PD tablets for oral suspension or Tivicay tablets as listed on the label. Tivicay tablets and Tivicay PD tablets for oral suspension are not the same and cannot be swapped milligram for milligram.
Common side effects
The label extract does not list common side effects with rates. The serious reactions discussed in the label are allergic (hypersensitivity) reactions, liver toxicity (hepatotoxicity), and immune reconstitution syndrome. Tell your care team about any unusual problems while taking this medicine.
Serious warnings
Allergic reactions with rash, general symptoms, and sometimes organ problems including liver injury have been reported. Stop Tivicay or Tivicay PD and other suspect medicines right away if signs of an allergic reaction develop, because a delay in stopping can lead to a life-threatening reaction. Liver toxicity has been reported, and people with hepatitis B or C underneath may have a higher risk of worsening or new rises in liver enzymes, so checking for liver toxicity is recommended. Immune reconstitution syndrome has been reported in people treated with combination antiretroviral therapy. Tivicay tablets and Tivicay PD tablets for oral suspension are not interchangeable.
Who should be careful
Do not take this medicine if you have had a prior allergic reaction to dolutegravir, and do not take it while receiving dofetilide. People with hepatitis B or C underneath need extra care because of the risk of liver enzyme rises. The label describes a pregnancy exposure registry that tracks outcomes in people exposed during pregnancy, and states that available human data do not show an increased risk of birth defects, while also noting there are not enough human data to fully assess the risk for birth defects and miscarriage.
Major interactions
Do not take dolutegravir with dofetilide, because dolutegravir can raise dofetilide levels and raise the risk of serious or life-threatening events; this combination is contraindicated on the label. Drugs that are metabolic inducers may lower dolutegravir levels. Take Tivicay or Tivicay PD 2 hours before or 6 hours after cation-containing antacids or laxatives, sucralfate, oral supplements containing iron or calcium, or buffered medicines. When taken with food, dolutegravir and calcium or iron supplements can be taken at the same time. The label extract says to see the full prescribing information for other important interactions.
Cost and saving notes
The pinned label for this page is the brand-name Tivicay and Tivicay PD label, so this page is based on the brand products. If your Part D plan places this drug on a high tier or does not cover it the way you need, you can ask the plan for a tier exception. If you have low income, Extra Help (the Low-Income Subsidy) can lower your Part D costs. Ask your plan and Medicare about both options.
Why it is in its tier
Dolutegravir (Tivicay) sits on Tier 5 in 87.53% of the plans that list it (4810 of 5495 listing plans). Tier 5 is the specialty tier — instead of a flat copay, patients usually pay a percentage of the drug's cost (coinsurance), which is why specialty drugs feel expensive even with coverage. The data-visible drivers: It is a brand-only product with no generic version in the formulary data, and the CMS dashboard puts its average Part D spending at about $21,551 per beneficiary for 2024 — among the highest-cost drugs in the program, which matches where plans place it. It is listed by 100.0% of Part D plans. The tier shown is the most common one; individual plans vary.
Sources
- TIVICAY PD (DOLUTEGRAVIR SODIUM) TABLET, FOR SUSPENSION TIVICAY (DOLUTEGRAVIR SODIUM) TABLET, FILM COATED [VIIV HEALTHCARE COMPANY] — DailyMed
- MedlinePlus — National Library of Medicine
- MedlinePlus — Dolutegravir
What official patient guides say
Dolutegravir comes as a tablet and as a tablet for suspension that you dissolve in liquid, and you take it by mouth once or twice a day, with or without food, at around the same time or times every day. Swallow the regular tablet whole. Do not chew, cut, or crush the tablets for suspension — stir them into drinking water only, drink the mix right away, and throw out any mix that has sat for more than 30 minutes. If you miss a dose, take it as soon as you remember it, and do not take a double dose to make up for one you missed. Keep the tablets in the container they came in, tightly closed and out of the reach of children, leave the small drying packet in the bottle, and store them at room temperature away from extra heat and moisture, not in the bathroom. Take unneeded medicine to a take-back program instead of flushing it.
Source: MedlinePlus — Dolutegravir
Part D formulary coverage
| Formulary summary | |
|---|---|
| Most common tier | 5 |
| Plans listing this drug | 5495 |
| Total Part D plans | 5495 |
| Share of plans listing it | 100 |
| Formularies listing it | 286 |
| Tier | Plans |
|---|---|
| Tier 1 | 123 plans |
| Tier 2 | 1 plans |
| Tier 3 | 100 plans |
| Tier 4 | 461 plans |
| Tier 5 | 4810 plans |
Source: CMS Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files — Monthly file 2026-10-15 (plan year 2027), file 2027_20261008.zip (data.cms.gov dataset ed1496ea-23e7-41f1-9292-172fa842ccfb): basic drugs formulary file + plan information file, both dated 20261031 inside the zip; downloaded and aggregated 2026-10-30. Medication RxCUI sets resolved through the NLM RxNav (RxNorm) API.
What you pay
| With Medicare Part D | |
|---|---|
| Most common tier | Tier 5 |
| Typical copay | $0 — half of plans charge between $0 and $0 |
| Typical coinsurance | 26.0% of the price |
| Based on | 4731 plans that cover this drug · 2027 plan year |
Without insurance, the cash benchmark is $77.643 per unit (TIVICAY 50 MG TABLET) — about $2329.29 for 30 units. NADAC benchmark — the average price pharmacies pay (CMS, as of 2026-11-04). Pharmacy shelf prices vary.
A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.
Sources: CMS Plan Benefit Package + formulary data; CMS NADAC · Checked 2026-11-07
Read next
Part D spending averages (2024)
| Brand name | Generic name | Total claims 2024 | Total spending 2024 | Total beneficiaries 2024 | Rank by beneficiaries 2024 |
|---|---|---|---|---|---|
| Tivicay | Dolutegravir Sodium | 255731 | 6.29401e+08 | 29205 | 708 |
| Tivicay Pd | Dolutegravir Sodium | 35 | 37772.2 | 0 | 3590 |
Source: CMS Medicare Part D Spending by Drug (Drug Spending Dashboard), release RY26 P04 V10, data through 2024 (DSD_PTD_RY26_P04_V10_DY24_BGM.csv), downloaded 2026-10-30
Companies covering this drug
5,495 plans from 509 companies list this drug on a formulary for 2027. Search by company or plan name, or filter by tier. Cost sharing is the plan's published amount for this drug's tier in the initial coverage stage (1-month retail supply), where the plan publishes it; a blank means the plan does not publish it.
| Company | Plan | Tier | Copay | Coinsurance |
|---|
A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.
Coverage and costs change. Drug lists (formularies), tiers, and copays can change during the year and differ by plan. Always check with your insurance company or plan directly to confirm what is covered and what you will pay.
Care and Living Guide is not connected with or endorsed by the U.S. government or the federal Medicare program. For official information visit Medicare.gov or call 1-800-MEDICARE.