Why is the comparison with Medicare for FETZIMA 20-40 MG TITRATION PAK labelled estimated?

Beyond what the card shows, the records give these reasons: The Part D figure covers 2024-01-01 to 2024-12-31; the NADAC price is from the file of 2026-10-14. Part D spending basis, as the Part D record states it: Part D 2024 average spend per dosage unit for Fetzima / Levomilnacipran HCl: all makers, strengths, forms and routes combined, claim-weighted; gross cost incl. dispensing fees and patient pay, before rebates. Unit taken as NADAC's EA. Joined on brand name.

Why does this page start at 1 unit (EA)?

NADAC prices this product per EA, and the FDA NDC Directory lists its NDC as dosage form “KIT” with route “ORAL”. Only a tablet, capsule, lozenge or troche with route “ORAL”, or a tablet or film with route “SUBLINGUAL” or “BUCCAL”, starts at 30, and this is not one. NADAC’s EA for it may be the whole kit or one item in it, and the files do not say which. So the card starts at 1 unit (EA) rather than guess how many make up a fill; change it to match your prescription.

FETZIMA 20-40 MG TITRATION PAK

FDA nonproprietary name: levomilnacipran hydrochloride

For 1 unit (EA)

Pharmacies pay

$17.61 filed

1 × $17.60658 per EA

CMS NADAC · nadac-national-average-drug-acquisition-cost-20261014.csv · eff. 2026-01-02 · as of 2026-10-14 · retrieved 2026-10-17

Medicare Part D paid

$16.46 filed

1 × $16.4564 per EA, Part D average

Medicare's price is not your price.

Medicare Part D · DSD_PTD_RY26_P04_V10_DY24_BGM.csv · eff. 2024-01-01 to 2024-12-31 · as of 2026-06-25 · retrieved 2026-10-18

The spread

0.93× estimated

Medicare paid 7% less than pharmacies pay.

Part D averages every strength and form sold under “Fetzima” / “Levomilnacipran HCl” into one figure, so it is not specific to this NDC.

OpenBill calculation · DSD_PTD_RY26_P04_V10_DY24_BGM.csv + nadac-national-average-drug-acquisition-cost-20261014.csv · NADAC eff. 2026-01-02 (file of 2026-10-14, retrieved 2026-10-17) · Part D 2024-01-01 to 2024-12-31 (file of 2026-06-25, retrieved 2026-10-18)

Cost-plus estimate

$25.25 estimated

$17.61 + $2.64 (15%) + $5.00 fee per fill = $25.25

This is a model, not a price any pharmacy quoted. Shipping is not included. How it is worked out

OpenBill calculation · nadac-national-average-drug-acquisition-cost-20261014.csv · NADAC eff. 2026-01-02 (file of 2026-10-14, retrieved 2026-10-17)

Open the interactive card Change the quantity, type what you were charged, and see every record in full.

What it is

FETZIMA 20-40 MG TITRATION PAK is how the CMS NADAC file names this product. The FDA NDC Directory lists it as levomilnacipran hydrochloride, under the trade name “Fetzima”.

FDA gives its dosage form as kit and its route as oral.

The labeler, the company named on the label, is Allergan, Inc.

FDA lists no Established Pharmacologic Class for it.

The NADAC file of 2026-10-14 prices it under one NDC (National Drug Code), 00456-2202-28.

NADAC classes it as a brand-name drug (rate-setting class B), and does not mark it as sold over the counter.

What pharmacies pay

Pharmacies pay $17.61 for 1 unit (EA) (1 × $17.60658 per EA, rounded to the cent), by the CMS NADAC file of 2026-10-14; that price took effect on 2026-01-02. That is what pharmacies pay their suppliers, not what they charge you.

NADAC’s explanation code for it: 4, carried forward from the previous file.

This NDC’s NADAC was carried forward from an earlier file (NADAC explanation code 2 or 4), not newly surveyed: it took effect on 2026-01-02. The file is new; the price is not.

What NADAC measures · NADAC explanation codes · Carried-forward prices

The NDC

00456-2202-28 · Allergan, Inc. · $17.60658 per EA · eff. 2026-01-02 filed carried forward

Other strengths, forms and brands

4 other products in the NADAC file share the FDA nonproprietary name levomilnacipran hydrochloride with FETZIMA 20-40 MG TITRATION PAK.

Product	Pharmacies pay per unit	Medicare per unit
FETZIMA 20-40 MG TITRATION PAK this page brand · kit	$17.60658 per EA filed eff. 2026-01-02	$16.4564 per EA filed Part D 2024 average
FETZIMA ER 20 MG CAPSULE brand · capsule, extended release	$17.59735 per EA filed eff. 2026-09-23	We don’t know yet
FETZIMA ER 40 MG CAPSULE brand · capsule, extended release	$17.61125 per EA filed eff. 2026-09-23	We don’t know yet
FETZIMA ER 80 MG CAPSULE brand · capsule, extended release	$17.5875 per EA filed eff. 2026-09-23	We don’t know yet
FETZIMA ER 120 MG CAPSULE brand · capsule, extended release	$17.58708 per EA filed eff. 2026-09-23	We don’t know yet

Part D is one average per brand and generic name, over every strength and form.

CMS NADAC · nadac-national-average-drug-acquisition-cost-20261014.csv · eff. 2026-01-02, 2026-09-23 · as of 2026-10-14 · retrieved 2026-10-17

Medicare Part D · DSD_PTD_RY26_P04_V10_DY24_BGM.csv · eff. 2024-01-01 to 2024-12-31 · as of 2026-06-25 · retrieved 2026-10-18

What Medicare paid

Medicare Part D paid $16.46 for 1 unit (EA), at an average of $16.4564 per EA in 2024 (2024-01-01 to 2024-12-31) for “Fetzima” and “Levomilnacipran HCl”, every strength and form sold under that name together (Medicare Part D Spending by Drug, file of 2026-06-25).

That average covers 39,287 Part D claims (fills, including refills) for 2024-01-01 to 2024-12-31, across every maker, strength and form under the name.

Medicare's price is not your price.

What Part D spending measures · Which Medicare figure OpenBill compares · How the spread is worked out

What to ask at the counter

None of these figures is your price: what you pay depends on your pharmacy, your insurance, coupons and discounts.

What is your cash price for 1 unit (EA)? Is it lower than what I would pay through my insurance?
If you have Medicare Part D: what is my plan’s copay or coinsurance for it? The Part D average on this page is not what you pay.
These are questions about price, not medical advice. Do not change or stop a medicine without talking to your prescriber or pharmacist.

Questions

Why is the comparison with Medicare for FETZIMA 20-40 MG TITRATION PAK labelled estimated?: Beyond what the card shows, the records give these reasons: The Part D figure covers 2024-01-01 to 2024-12-31; the NADAC price is from the file of 2026-10-14. Part D spending basis, as the Part D record states it: Part D 2024 average spend per dosage unit for Fetzima / Levomilnacipran HCl: all makers, strengths, forms and routes combined, claim-weighted; gross cost incl. dispensing fees and patient pay, before rebates. Unit taken as NADAC's EA. Joined on brand name.
Why does this page start at 1 unit (EA)?: NADAC prices this product per EA, and the FDA NDC Directory lists its NDC as dosage form “KIT” with route “ORAL”. Only a tablet, capsule, lozenge or troche with route “ORAL”, or a tablet or film with route “SUBLINGUAL” or “BUCCAL”, starts at 30, and this is not one. NADAC’s EA for it may be the whole kit or one item in it, and the files do not say which. So the card starts at 1 unit (EA) rather than guess how many make up a fill; change it to match your prescription.