0.4 ML adalimumab-aaty 100 MG/ML Prefilled Syringe
adalimumab-aaty
RxCUI: 2639659
Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.
18.9%
Plan Coverage
958
Plans Covering
T4.4
Avg Tier
100%
Prior Auth Required
What the CMS Formulary Data Shows for 0.4 ML adalimumab-aaty 100 MG/ML Prefilled Syringe
Per the CMS 2026 Part D formulary file, 0.4 ML adalimumab-aaty 100 MG/ML Prefilled Syringe (RxNorm concept RXCUI 2639659, generic name adalimumab-aaty) appears on 35 distinct formulary files spanning 958 Medicare Part D plan offerings - 18.9% 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 4.4.
Real-world access to 0.4 ML adalimumab-aaty 100 MG/ML Prefilled Syringe depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 85.7% 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-aaty 100 MG/ML Prefilled Syringe today.
Coverage Details
- Formularies covering
- 35
- Plans covering
- 958
- Coverage rate
- 18.9%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 85.7% of formularies
Tier Distribution Across Plans
25 plans
Tier 1, Preferred Generic
75 plans
Tier 5, Specialty
Standalone Drug Plans (PDP) Covering 0.4 ML adalimumab-aaty 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-aaty 100 MG/ML Prefilled Syringe
95 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| NaviCare (HMO D-SNP) | FALLON COMMUNITY HEALTH PLAN | T1 | Yes | $0 | MA |
| 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 Maryland Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | Yes | $0 | MD |
| Provider Partners Missouri Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | Yes | $0 | MO |
| Mass General Brigham SCO (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | Yes | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | Yes | $0 | MA |
| 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 Maryland Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | Yes | $31.20 | MD |
| Provider Partners Maryland Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | Yes | $31.20 | MD |
| 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 |
| UHC Dual Complete MO-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T5 | Yes | $0 | MO |
| UHC Dual Complete NE-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T5 | Yes | $0 | NE |
| UHC Dual Complete KS-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T5 | Yes | $0 | KS |
| UHC Dual Complete MO-S3 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T5 | Yes | $0 | MO |
| UHC Dual Complete KS-Q1 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T5 | Yes | $0 | KS |
| UHC Dual Complete TN-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T5 | Yes | $0 | TN |
| UHC Dual Complete TN-Y001 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T5 | Yes | $0 | TN |
| UHC Dual Complete TN-Y2 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T5 | Yes | $0 | TN |
| AARP Medicare Advantage from UHC MI-0001 (PPO) | UNITEDHEALTHCARE INSURANCE COMPANY | T5 | Yes | $0 | MI |
| UHC Dual Complete NM-Y1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T5 | Yes | $0 | NM |
| UHC Dual Complete NM-S1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T5 | Yes | $0 | NM |
| UHC Dual Complete NM-V1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T5 | Yes | $0 | NM |
| UHC Dual Complete AZ-S001 (HMO-POS D-SNP) | ARIZONA PHYSICIANS IPA, INC. | T5 | Yes | $0 | AZ |
| UHC Dual Complete AZ-Y001 (HMO-POS D-SNP) | ARIZONA PHYSICIANS IPA, INC. | T5 | Yes | $0 | AZ |
| UHC Dual Complete VA-Y4 (PPO D-SNP) | CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO. | T5 | Yes | $0 | VA |
| AARP Medicare Advantage from UHC AL-0001 (HMO-POS) | UNITEDHEALTHCARE OF THE MIDLANDS, INC. | T5 | Yes | $0 | AL |
| AARP Medicare Advantage from UHC CA-0002 (HMO-POS) | UHC OF CALIFORNIA | T5 | Yes | $0 | CA |
| UHC Sharp Medicare Advantage CA-001P (HMO-POS) | UHC OF CALIFORNIA | T5 | Yes | $0 | CA |
| AARP Medicare Advantage from UHC CA-003P (HMO-POS) | UHC OF CALIFORNIA | T5 | Yes | $0 | CA |
| AARP Medicare Advantage from UHC CA-0012 (HMO-POS) | UHC OF CALIFORNIA | T5 | Yes | $0 | CA |
| AARP Medicare Advantage from UHC CA-004P (HMO-POS) | UHC OF CALIFORNIA | T5 | Yes | $0 | CA |
| AARP Medicare Advantage from UHC CA-005P (HMO-POS) | UHC OF CALIFORNIA | T5 | Yes | $0 | CA |
| AARP Medicare Advantage from UHC CA-006P (HMO-POS) | UHC OF CALIFORNIA | T5 | Yes | $0 | CA |
| AARP Medicare Advantage from UHC CA-10 (HMO-POS) | UHC OF CALIFORNIA | T5 | Yes | $0 | CA |
Frequently Asked Questions
Is 0.4 ML adalimumab-aaty 100 MG/ML Prefilled Syringe covered by Medicare Part D?
Yes, 0.4 ML adalimumab-aaty 100 MG/ML Prefilled Syringe is covered by 958 Medicare Part D plans (18.9% of all Part D formularies).
What tier is 0.4 ML adalimumab-aaty 100 MG/ML Prefilled Syringe on Medicare Part D plans?
0.4 ML adalimumab-aaty 100 MG/ML Prefilled Syringe averages Tier 4.4 across Part D plans, ranging from Tier 1 to Tier 5.
Does 0.4 ML adalimumab-aaty 100 MG/ML Prefilled Syringe require prior authorization?
100% of Part D formularies require prior authorization for 0.4 ML adalimumab-aaty 100 MG/ML Prefilled Syringe. Step therapy: 0%. Quantity limits: 85.7%.
Read our methodology - how this data is sourced, computed, and verified.
Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare Editorial