Pimavanserin (Nuplazid)

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.

What it treats

It treats hallucinations (seeing or hearing things that are not there) and delusions (false beliefs) that come with Parkinson's disease psychosis.

What it is for, in depth

This drug is for hallucinations and delusions linked to Parkinson's disease psychosis — when a person with Parkinson's sees, hears, or believes things that are not real. It is prescribed for people with Parkinson's disease who develop these psychosis symptoms. The label does not place it in a step-by-step treatment path beyond this use. It comes as a 34 mg capsule (40 mg of the tartrate salt, equal to 34 mg of pimavanserin) and as a 10 mg coated tablet (11.8 mg of the tartrate salt, equal to 10 mg), both taken by mouth.

How it works

The label says the exact way pimavanserin works is not clear. It says the effect may come from blocking and calming serotonin 5-HT2A receptors in the brain, and to a lesser extent 5-HT2C receptors. The label calls it an atypical antipsychotic.

How it is taken

The usual dose is 34 mg by mouth once a day, with no slow dose build-up. It can be taken with or without food. Capsules can be swallowed whole, or opened and the whole contents sprinkled over a tablespoon of certain soft foods.

Common side effects

The label extract provided does not list common, everyday side effects. Its adverse reactions section only points to the serious reactions covered in the boxed warning and warnings: increased risk of death in older adults with dementia-related psychosis, and lengthening of the QT interval (a heart rhythm measure).

Serious warnings

It lengthens the QT interval, which can affect heart rhythm, so the label says to avoid it with other drugs that also lengthen the QT interval and in people who have risk factors for a long QT interval. Allergic reactions have been reported, including rash, hives, and swelling reactions like tongue swelling, swelling around the mouth, throat tightness, and trouble breathing.

Boxed warning

Older adults with dementia-related psychosis who are treated with antipsychotic drugs have a higher risk of death. NUPLAZID is not approved for treating people with dementia who have psychosis, unless their hallucinations and delusions are related to Parkinson's disease.

Who should be careful

People with risk factors for a long QT interval, and people who have had an allergic reaction to pimavanserin or any of its ingredients, should be careful — it must not be used after such a reaction. For pregnancy, the label says there are no data in pregnant women to judge the risk; in animal studies, giving it during pregnancy and nursing caused harm to the mother and lower pup survival and weight at doses about twice the top human dose.

Major interactions

Strong CYP3A4 inhibitor drugs raise its level, so the dose must be lowered to 10 mg once a day when one is used. Strong or moderate CYP3A4 inducer drugs should be avoided with it. Drugs that also lengthen the QT interval should be avoided.

Cost and saving notes

Pimavanserin is sold as the brand drug Nuplazid, and generic pimavanserin capsules are also marketed — ask your plan or pharmacist whether a generic version is on your plan's drug list, since that can change your cost. If your cost is still high, ask your plan about a tier exception (asking the plan to charge a lower tier for your drug) and check whether you qualify for Extra Help, the Medicare program that lowers Part D premiums and copays for people with limited income. Part D has an annual out-of-pocket cap, so once your yearly drug costs reach the cap you pay nothing more for covered Part D drugs that year.

Why it is in its tier

Pimavanserin (Nuplazid) sits on Tier 5 in 94.23% of the plans that list it (5178 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 $38,420 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

• NUPLAZID (PIMAVANSERIN TARTRATE) CAPSULE NUPLAZID (PIMAVANSERIN TARTRATE) TABLET, COATED [ACADIA PHARMACEUTICALS INC.] — DailyMed
• MedlinePlus — National Library of Medicine
• MedlinePlus

What official patient guides say

In daily life, pimavanserin is a once-a-day tablet or capsule, taken at about the same time each day, with or without food. If swallowing is hard, the capsule can be opened and sprinkled on a tablespoon of applesauce, yogurt, pudding, or a liquid nutrition drink, and the mixture should be eaten or drunk right away without chewing and not saved for later. MedlinePlus advises keeping a written list of all your medicines, vitamins, and supplements to bring to every doctor visit and to carry in case of emergency. Tell your care team if you or a family member has ever had QT prolongation, a slow or irregular heartbeat, or low potassium or magnesium. Keep the medicine in its tightly closed container at room temperature, away from heat and moisture, and protect the capsules from light.

Source: MedlinePlus

Part D formulary coverage

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

Without insurance, the cash benchmark is 170.496 per unit (NUPLAZID 34 MG CAPSULE) — about nan 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 2026-11-08

Coverage by plan and tier

Of the 5,495 Medicare drug plans we track for 2027, 5,495 list Pimavanserin (Nuplazid) — 100% of plans. Most of those plans put it on Tier 5: 5,178 plans, 94.2% of the plans that list it. Other plans place it on Tier 4 (193 plans), Tier 1 (123 plans) or Tier 2 (1 plans). For example: Aetna Medicare Dual Extra (HMO D-SNP) puts it on Tier 5; Aetna Medicare Dual Extra Care (PPO D-SNP) puts it on Tier 5; Aetna Medicare Value Plus (PPO) puts it on Tier 5. You can compare these plans side by side on our Medicare Advantage hub. A tier is not a price. What you pay also depends on whether you have met your plan';s deductible, whether the drug costs a flat copay or a share of the price, and whether you get Extra Help or Medicaid.

Read next

• Part D in 2027: The $700 Deductible, the $2,400 Cap, and the $35 Insulin Rule
• Extra Help in 2027: Lower Drug Copays and Who Qualifies
• Checking Medicare Savings Programs and Extra Help

Part D spending averages (2024)

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

Part D and Medicare Advantage plan sponsors that list this drug on a formulary, 50 at a time.