Medicare Part D coverage · 0.4 · RxCUI 2680743
0.4 ML adalimumab-adbm 100 MG/ML Prefilled Syringe
Per the CMS 2026 Part D formulary file, 0.4 ML adalimumab-adbm 100 MG/ML Prefilled Syringe is covered by 1,830 Medicare Part D plans (36.2% of enrollable products), averaging Tier 4.8, with prior authorization required on 92.9% of covering formularies.
- 36.2%
- Plan coverage
- 1,830
- Plans covering
- T4.8
- Avg tier
- 92.9%
- Prior auth required
What the CMS Formulary Data Shows for 0.4 ML adalimumab-adbm 100 MG/ML Prefilled Syringe
Per the CMS 2026 Part D formulary file, 0.4 ML adalimumab-adbm 100 MG/ML Prefilled Syringe (RxNorm concept RXCUI 2680743, generic name 0.4) appears on 42 distinct formulary files spanning 1,830 Medicare Part D plan offerings - 36.2% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.8.
Real-world access to 0.4 ML adalimumab-adbm 100 MG/ML Prefilled Syringe depends on utilization management as much as tier placement: 92.9% of covering formularies require prior authorization. 0% require step therapy. 92.9% apply quantity limits.
Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 0.4 ML adalimumab-adbm 100 MG/ML Prefilled Syringe today.
Coverage Details
- Formularies covering
- 42
- Plans covering
- 1,830
- Coverage rate
- 36.2%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 5, Specialty
Restrictions
- Prior authorization required
- 92.9% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 92.9% of formularies
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering 0.4 ML adalimumab-adbm 100 MG/ML Prefilled Syringe
5 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T5 | Yes | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering 0.4 ML adalimumab-adbm 100 MG/ML Prefilled Syringe
95 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | Yes | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | Yes | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $0 | MO |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | Yes | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | Yes | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | Yes | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | Yes | $0 | MA |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | Yes | $4.80 | TX |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Illinois | T1 | Yes | $15.20 | IL |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $32.70 | PA |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $32.70 | PA |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | Yes | $36.20 | NC |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | Yes | $36.20 | NC |
| Provider Partners Indiana Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | Yes | $38.40 | IN |
| Provider Partners Indiana Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | Yes | $38.40 | IN |
| Provider Partners Kentucky Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Kentucky | T1 | Yes | $38.40 | KY |
| Provider Partners Missouri Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $43.00 | MO |
| Provider Partners Missouri Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $43.00 | MO |
| UHC Dual Complete IA-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T5 | Yes | $0 | IA |
Show the next 30 plans
Showing top 50 of 95 plans.
Frequently Asked Questions
Is 0.4 ML adalimumab-adbm 100 MG/ML Prefilled Syringe covered by Medicare Part D?
Yes, 0.4 ML adalimumab-adbm 100 MG/ML Prefilled Syringe is covered by 1,830 Medicare Part D plans (36.2% of all Part D formularies).
What tier is 0.4 ML adalimumab-adbm 100 MG/ML Prefilled Syringe on Medicare Part D plans?
0.4 ML adalimumab-adbm 100 MG/ML Prefilled Syringe averages Tier 4.8 across Part D plans, ranging from Tier 1 to Tier 5.
Does 0.4 ML adalimumab-adbm 100 MG/ML Prefilled Syringe require prior authorization?
92.9% of Part D formularies require prior authorization for 0.4 ML adalimumab-adbm 100 MG/ML Prefilled Syringe. Step therapy: 0%. Quantity limits: 92.9%.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
- emtricitabine 200 MG / rilpivirine 25 MG / tenofovir disoproxil fumarate 300 MG Oral Tablet [Complera] T4.8
- selegiline hydrochloride 1.25 MG Disintegrating Oral Tablet [Zelapar] T4.8
- eltrombopag 25 MG Oral Tablet [Promacta] T4.8
- mercaptopurine 20 MG/ML Oral Suspension [Purixan] T4.8
- prednisone 1 MG Delayed Release Oral Tablet T4.8
- eltrombopag 25 MG Powder for Oral Suspension [Promacta] T4.8
Similar prior-authorization rate
- 1 ML lanadelumab-flyo 150 MG/ML Prefilled Syringe [Takhzyro] 92.9% PA
- insulin lispro 100 UNT/ML Injectable Solution [Admelog] 93% PA
- {28 (alpelisib 50 MG Oral Granules [Vijoice]) } Pack [Vijoice 50 MG Granules 28 Day] 93% PA
- 0.5 ML tbo-filgrastim 0.6 MG/ML Prefilled Syringe [Granix] 93% PA
- 0.8 ML tbo-filgrastim 0.6 MG/ML Prefilled Syringe [Granix] 93% PA
- 0.6 ML pegfilgrastim-bmez 10 MG/ML Prefilled Syringe [Ziextenzo] 93.1% PA