Medicare Part D coverage · 0.4 · RxCUI 2640894
0.4 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo]
Per the CMS 2026 Part D formulary file, 0.4 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo] is covered by 476 Medicare Part D plans (9.4% of enrollable products), averaging Tier 4, with prior authorization required on 100% of covering formularies.
- 9.4%
- Plan coverage
- 476
- Plans covering
- T4
- Avg tier
- 100%
- Prior auth required
What the CMS Formulary Data Shows for 0.4 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo]
Per the CMS 2026 Part D formulary file, 0.4 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo] (RxNorm concept RXCUI 2640894, generic name 0.4) appears on 61 distinct formulary files spanning 476 Medicare Part D plan offerings - 9.4% 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.
Real-world access to 0.4 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 21.3% 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 50 MG/ML Prefilled Syringe [Cyltezo] today.
Coverage Details
- Formularies covering
- 61
- Plans covering
- 476
- Coverage rate
- 9.4%
- 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
- 21.3% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 0.4 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | Yes | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | Yes | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $0 | NY |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $0 | AR |
| 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 |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Tribute Select (HMO-POS I-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $8.90 | AR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | Yes | $17.00 | AZ |
| Alterwood Advantage Dual Value (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $31.20 | MD |
| Valor Health Plan (HMO I-SNP) | TSG Guard, Inc. | T1 | Yes | $31.40 | OH |
| WV Senior Advantage (HMO I-SNP) | West Virginia Senior Advantage, Inc. | T1 | Yes | $32.70 | WV |
Show the next 30 plans
| Abilis Health (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $35.90 | KY, TN |
| CommuniCare Advantage ISNP (HMO I-SNP) | OH CHS SNP Inc. | T1 | Yes | $38.40 | IN, MD, OH |
| Nascentia Skilled Nursing Facility (HMO I-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $58.80 | NY |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T4 | Yes | $0 | CA |
| DualConnect (HMO D-SNP) | Santa Clara County Health Authority | T4 | Yes | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T4 | Yes | $0 | NY |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS Choice | T4 | Yes | $51.60 | NY |
| Wellcare Simple (HMO-POS) | Coordinated Care OF Washington, Inc. | T5 | Yes | $0 | WA |
| Wellcare Simple Open (PPO) | Wellcare OF Mississippi, Inc. | T5 | Yes | $0 | MS |
| Wellcare Simple Open (PPO) | Wellcare OF Georgia, Inc. | T5 | Yes | $0 | GA |
| Wellcare Simple (HMO) | Wellcare OF Texas, Inc. | T5 | Yes | $0 | TX |
| Wellcare Simple (HMO) | Wellcare OF Texas, Inc. | T5 | Yes | $0 | TX |
| Wellcare Simple (HMO) | Wellcare OF Texas, Inc. | T5 | Yes | $0 | TX |
| Wellcare Simple (HMO) | Wellcare OF Texas, Inc. | T5 | Yes | $0 | TX |
| Wellcare Simple Open (PPO) | Wellcare Health Insurance Company OF America | T5 | Yes | $0 | AR |
| Wellcare Simple (HMO) | Health NET OF Arizona, Inc. | T5 | Yes | $0 | AZ |
| Wellcare Simple (HMO) | Health NET OF Arizona, Inc. | T5 | Yes | $0 | AZ |
| Wellcare Simple Value (HMO) | Health NET OF Arizona, Inc. | T5 | Yes | $0 | AZ |
| Wellcare Simple (HMO-POS) | Health NET OF Arizona, Inc. | T5 | Yes | $0 | NV |
| Wellcare Simple (HMO-POS) | Health NET OF Arizona, Inc. | T5 | Yes | $0 | NV |
| Wellcare Low Premium (HMO) | Health NET OF California, Inc. | T5 | Yes | $0 | CA |
| Wellcare Simple Focus (HMO) | Health NET OF California, Inc. | T5 | Yes | $0 | CA |
| Wellcare Simple Focus (HMO) | Health NET OF California, Inc. | T5 | Yes | $0 | CA |
| Wellcare Low Premium (HMO) | Health NET OF California, Inc. | T5 | Yes | $0 | CA |
| Wellcare Low Premium (HMO) | Health NET OF California, Inc. | T5 | Yes | $0 | CA |
| Wellcare Simple (HMO-POS) | Wellcare OF Connecticut, Inc. | T5 | Yes | $0 | CT |
| Wellcare Giveback (HMO-POS) | Wellcare OF Connecticut, Inc. | T5 | Yes | $0 | CT |
| Wellcare Simple (HMO-POS) | Buckeye Community Health Plan, Inc. | T5 | Yes | $0 | OH |
| Wellcare Low Premium (HMO-POS) | Wellcare Health Plans OF NEW Jersey, Inc. | T5 | Yes | $0 | NJ |
| Wellcare Giveback (HMO-POS) | Wellcare Health Plans OF NEW Jersey, Inc. | T5 | Yes | $0 | NJ |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 0.4 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo] covered by Medicare Part D?
Yes, 0.4 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo] is covered by 476 Medicare Part D plans (9.4% of all Part D formularies).
What tier is 0.4 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo] on Medicare Part D plans?
0.4 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo] averages Tier 4 across Part D plans, ranging from Tier 1 to Tier 5.
Does 0.4 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo] require prior authorization?
100% of Part D formularies require prior authorization for 0.4 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo]. Step therapy: 0%. Quantity limits: 21.3%.
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
- risperidone 50 MG Injection T4
- mavacamten 10 MG Oral Capsule [Camzyos] T4
- 0.2 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo] T4
- 0.8 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo] T4
- {12 (siponimod 0.25 MG Oral Tablet [Mayzent]) } Pack [Mayzent 2 MG Starter Pack] T4
- {10 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 10 Tablet Pack] T4
Similar prior-authorization rate
- azathioprine 50 MG Oral Tablet 100% PA
- 0.5 ML hepatitis B surface antigen vaccine 0.04 MG/ML Prefilled Syringe [Heplisav-B] 100% PA
- 0.5 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] 100% PA
- 1 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] 100% PA
- sotagliflozin 200 MG Oral Tablet [Inpefa] 100% PA
- mycophenolate mofetil 250 MG Oral Capsule 100% PA