Pitavastatin calcium (Livalo)

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

Lowering LDL cholesterol (the 'bad' cholesterol). It is used along with diet in adults with primary hyperlipidemia (high cholesterol) and in adults and children 8 years and older with heterozygous familial hypercholesterolemia, an inherited condition that causes high cholesterol.

What it is for, in depth

LIVALO (pitavastatin calcium) is a statin tablet used along with diet — not instead of diet — to lower LDL cholesterol. It is prescribed for adults with primary hyperlipidemia, the common form of high cholesterol, and for adults and children age 8 and older with heterozygous familial hypercholesterolemia (HeFH), an inherited condition in which the body cannot clear LDL cholesterol normally. In the treatment path it is a daily, long-term cholesterol-lowering tablet: the usual dose is 2 mg to 4 mg once a day, and the label says that patients who need a high-intensity statin, or who cannot reach their LDL goal on 4 mg a day, should be prescribed a different or additional LDL-lowering treatment. It comes as film-coated tablets in 1 mg, 2 mg, and 4 mg strengths (each stated as pitavastatin, equal to 1.045 mg, 2.09 mg, and 4.18 mg of pitavastatin calcium).

How it works

Pitavastatin is a statin. It blocks an enzyme called HMG-CoA reductase, which the liver needs for a key early step in making cholesterol. With less cholesterol made in the liver, the liver puts out more LDL receptors and pulls more LDL cholesterol out of the blood, so cholesterol levels in the blood go down. It also lowers levels of very low density lipoproteins (VLDL).

How it is taken

Take the tablet by mouth once a day, with or without food, at the same time each day. The recommended dose is 2 mg to 4 mg once a day, and 4 mg once a day is the maximum. People with moderate or severe kidney impairment, and people on hemodialysis for end-stage kidney disease, should start at 1 mg once a day and take no more than 2 mg once a day. Your LDL cholesterol can be checked as early as 4 weeks after starting, and the dose adjusted if needed.

Common side effects

The label sections provided do not list common side effects with rates or percentages. The adverse-reaction section points to the serious reactions discussed elsewhere on the label: muscle disease and muscle breakdown, an autoimmune muscle condition, liver problems, and increases in HbA1c and fasting blood sugar levels.

Serious warnings

This drug can cause myopathy (muscle disease) and rhabdomyolysis (serious muscle breakdown that can harm the kidneys). Stop the drug and get medical care for unexplained muscle pain, tenderness, or weakness, especially with fever or feeling generally ill. Rare cases of immune-mediated necrotizing myopathy, an autoimmune muscle condition, have been reported, and the drug should be stopped if it is suspected. Liver problems can also occur: increases in liver enzymes have happened, some lasting, and there have been rare reports of fatal and non-fatal liver failure. Stop the drug promptly if serious liver injury occurs with symptoms, high bilirubin, or jaundice (yellowing of the skin or eyes).

Who should be careful

The risk of muscle problems is higher in people age 65 or older, people with uncontrolled hypothyroidism (underactive thyroid), people with kidney impairment, people taking certain other drugs, and people on higher doses. Do not take this drug if you have acute liver failure or decompensated cirrhosis, or if you are allergic to pitavastatin or any ingredient in the tablet; allergic reactions reported include swelling (angioedema), rash, itching, and hives. This drug may cause fetal harm during pregnancy, and breastfeeding is not recommended during treatment.

Major interactions

Cyclosporine must not be taken with LIVALO — it greatly raises pitavastatin levels and the risk of muscle breakdown, so the combination is contraindicated. Avoid taking gemfibrozil with it. If you take erythromycin, do not take more than 1 mg of LIVALO a day; if you take rifampin, do not take more than 2 mg a day. Other cholesterol drugs — fibrates and lipid-modifying doses of niacin (1 gram a day or more) — and colchicine can also raise the risk of muscle problems when taken with it, so the benefit and risk should be weighed.

Cost and saving notes

Medicare Part D plans place drugs on tiers, and a higher tier usually means a higher copay or coinsurance. If your doctor says you need this drug and your plan's tier makes it costly, you or your doctor can ask the plan for a tier exception. If you have limited income, the Extra Help program (the Part D Low Income Subsidy) may lower your Part D premium, deductible, and drug costs if you qualify.

Why it is in its tier

Pitavastatin calcium (Livalo) sits on Tier 3 in 44.92% of the plans that list it (1874 of 4172 listing plans). Tier 3 is the preferred brand tier — mid-level copays or coinsurance. The data-visible drivers: It is sold both as a brand product and in generic form, and the CMS dashboard puts its average Part D spending at about $755 per beneficiary for 2024 — a relatively low-cost drug, which matches where plans place it. It is listed by 75.92% of Part D plans. The tier shown is the most common one; individual plans vary.

Sources

• LIVALO (PITAVASTATIN CALCIUM) TABLET, FILM COATED [KOWA PHARMACEUTICALS AMERICA, INC.] — DailyMed
• MedlinePlus — National Library of Medicine
• MedlinePlus — Pitavastatin

What official patient guides say

Pitavastatin comes as a tablet to take by mouth once a day, with or without food, at around the same time every day, and it should be taken exactly as directed — do not take more or less of it or take it more often than prescribed by your doctor. Your doctor may start you on a low dose and gradually increase your dose, not more than once every 4 weeks, and you should continue to take pitavastatin even if you feel well and not stop taking it without talking to your doctor. If you forget a dose, take the missed dose as soon as you remember it, but if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule; do not take a double dose to make up for a missed one. Store it in the container it came in, tightly closed and out of reach of children, at room temperature and away from light, excess heat and moisture (not in the bathroom).

Source: MedlinePlus — Pitavastatin

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 10.18775 per unit (LIVALO 1 MG TABLET) — 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, 4,172 list Pitavastatin calcium (Livalo) — 75.9% of plans. Most of those plans put it on Tier 3: 1,874 plans, 44.9% of the plans that list it. Other plans place it on Tier 1 (1,756 plans), Tier 2 (318 plans) or Tier 4 (133 plans). For example: Aetna Medicare Dual Extra (HMO D-SNP) puts it on Tier 1; Aetna Medicare Dual Extra Care (PPO D-SNP) puts it on Tier 1; Aetna Medicare Value Plus (PPO) puts it on Tier 1. 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.