Medicare Part D coverage · 0.4 · RxCUI 2596445
0.4 ML mepolizumab 100 MG/ML Prefilled Syringe [Nucala]
Per the CMS 2026 Part D formulary file, 0.4 ML mepolizumab 100 MG/ML Prefilled Syringe [Nucala] is covered by 2,442 Medicare Part D plans (48.3% of enrollable products), averaging Tier 4, with prior authorization required on 100% of covering formularies.
- 48.3%
- Plan coverage
- 2,442
- Plans covering
- T4
- Avg tier
- 100%
- Prior auth required
What the CMS Formulary Data Shows for 0.4 ML mepolizumab 100 MG/ML Prefilled Syringe [Nucala]
Per the CMS 2026 Part D formulary file, 0.4 ML mepolizumab 100 MG/ML Prefilled Syringe [Nucala] (RxNorm concept RXCUI 2596445, generic name 0.4) appears on 165 distinct formulary files spanning 2,442 Medicare Part D plan offerings - 48.3% 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 mepolizumab 100 MG/ML Prefilled Syringe [Nucala] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 93.9% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 7,618 Part D beneficiaries filled 0.4 ML mepolizumab 100 MG/ML Prefilled Syringe [Nucala] in 2023, with total plan-and-beneficiary spending of $260,986,344 and an average per-beneficiary annual cost of $34,259.17. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 0.4 ML mepolizumab 100 MG/ML Prefilled Syringe [Nucala] today.
Coverage Details
- Formularies covering
- 165
- Plans covering
- 2,442
- Coverage rate
- 48.3%
- 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
- 93.9% of formularies
2023 Medicare Spending
- Beneficiaries
- 7,618
- Total spending
- $260,986,344
- Avg per beneficiary
- $34,259.17
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 0.4 ML mepolizumab 100 MG/ML Prefilled Syringe [Nucala]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | Yes | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | Yes | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | Yes | $0 | NJ |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | Yes | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | Yes | $0 | GA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | Yes | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | Yes | $0 | AL |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | Yes | $0 | CA |
| 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 |
Show the next 30 plans
| 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 |
| 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 |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | Yes | $0 | WI |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | Yes | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | American Health Plan OF FL, Inc. | T1 | Yes | $4.80 | FL |
| SECUR Advantage (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| SECUR Enhanced (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | Yes | $4.80 | TX |
| 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 |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | Yes | $8.80 | MI |
| Senior Care (HMO I-SNP) | Align Senior Care MI, LLC | T1 | Yes | $8.80 | MI |
| Tribute Select (HMO-POS I-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $8.90 | AR |
| AgeRight Advantage Health Plan (HMO I-SNP) | Marquis Advantage, Inc. | T1 | Yes | $10.50 | OR, WA |
| 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 |
| Senior Care (HMO I-SNP) | Align Senior Care California Inc. | T1 | Yes | $12.00 | CA |
| Liberty Medicare Dual Plan (HMO D-SNP) | Liberty Advantage, LLC | T1 | Yes | $14.70 | NC |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Illinois, Inc. | T1 | Yes | $15.20 | IL |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Illinois | T1 | Yes | $15.20 | IL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | Yes | $17.00 | AZ |
| WellSense Added Value (HMO) | Boston Medical Center Health Plan, Inc. | T1 | Yes | $21.70 | NH |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 0.4 ML mepolizumab 100 MG/ML Prefilled Syringe [Nucala] covered by Medicare Part D?
Yes, 0.4 ML mepolizumab 100 MG/ML Prefilled Syringe [Nucala] is covered by 2,442 Medicare Part D plans (48.3% of all Part D formularies).
What tier is 0.4 ML mepolizumab 100 MG/ML Prefilled Syringe [Nucala] on Medicare Part D plans?
0.4 ML mepolizumab 100 MG/ML Prefilled Syringe [Nucala] averages Tier 4 across Part D plans, ranging from Tier 1 to Tier 5.
Does 0.4 ML mepolizumab 100 MG/ML Prefilled Syringe [Nucala] require prior authorization?
100% of Part D formularies require prior authorization for 0.4 ML mepolizumab 100 MG/ML Prefilled Syringe [Nucala]. Step therapy: 0%. Quantity limits: 93.9%.
How much does Medicare spend on 0.4 ML mepolizumab 100 MG/ML Prefilled Syringe [Nucala]?
In 2023, total Medicare Part D spending on 0.4 ML mepolizumab 100 MG/ML Prefilled Syringe [Nucala] was $260,986,344, covering 7,618 beneficiaries. The average spend per beneficiary was $34,259.17.
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
Similar prior-authorization rate
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