Medicare Part D coverage · 0.4 · RxCUI 1925255
0.4 ML abatacept 125 MG/ML Prefilled Syringe [Orencia]
Per the CMS 2026 Part D formulary file, 0.4 ML abatacept 125 MG/ML Prefilled Syringe [Orencia] is covered by 1,047 Medicare Part D plans (20.7% of enrollable products), averaging Tier 4.1, with prior authorization required on 98.8% of covering formularies.
- 20.7%
- Plan coverage
- 1,047
- Plans covering
- T4.1
- Avg tier
- 98.8%
- Prior auth required
What the CMS Formulary Data Shows for 0.4 ML abatacept 125 MG/ML Prefilled Syringe [Orencia]
Per the CMS 2026 Part D formulary file, 0.4 ML abatacept 125 MG/ML Prefilled Syringe [Orencia] (RxNorm concept RXCUI 1925255, generic name 0.4) appears on 171 distinct formulary files spanning 1,047 Medicare Part D plan offerings - 20.7% 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 4.1.
Real-world access to 0.4 ML abatacept 125 MG/ML Prefilled Syringe [Orencia] depends on utilization management as much as tier placement: 98.8% of covering formularies require prior authorization. 0% require step therapy. 65.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 1,749 Part D beneficiaries filled 0.4 ML abatacept 125 MG/ML Prefilled Syringe [Orencia] in 2023, with total plan-and-beneficiary spending of $53,626,257 and an average per-beneficiary annual cost of $30,661.10. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 0.4 ML abatacept 125 MG/ML Prefilled Syringe [Orencia] today.
Coverage Details
- Formularies covering
- 171
- Plans covering
- 1,047
- Coverage rate
- 20.7%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 98.8% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 65.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,749
- Total spending
- $53,626,257
- Avg per beneficiary
- $30,661.10
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 0.4 ML abatacept 125 MG/ML Prefilled Syringe [Orencia]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | Yes | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | Yes | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| 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 |
| 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 |
Show the next 30 plans
| 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 | No | $0 | WI |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Advance (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Plus (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| 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 |
| 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 |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Hcsc Insurance Services Company | T1 | Yes | $4.80 | TX |
| 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 |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS Insurance Company | T1 | Yes | $5.00 | OK |
| 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 |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 0.4 ML abatacept 125 MG/ML Prefilled Syringe [Orencia] covered by Medicare Part D?
Yes, 0.4 ML abatacept 125 MG/ML Prefilled Syringe [Orencia] is covered by 1,047 Medicare Part D plans (20.7% of all Part D formularies).
What tier is 0.4 ML abatacept 125 MG/ML Prefilled Syringe [Orencia] on Medicare Part D plans?
0.4 ML abatacept 125 MG/ML Prefilled Syringe [Orencia] averages Tier 4.1 across Part D plans, ranging from Tier 1 to Tier 5.
Does 0.4 ML abatacept 125 MG/ML Prefilled Syringe [Orencia] require prior authorization?
98.8% of Part D formularies require prior authorization for 0.4 ML abatacept 125 MG/ML Prefilled Syringe [Orencia]. Step therapy: 0%. Quantity limits: 65.5%.
How much does Medicare spend on 0.4 ML abatacept 125 MG/ML Prefilled Syringe [Orencia]?
In 2023, total Medicare Part D spending on 0.4 ML abatacept 125 MG/ML Prefilled Syringe [Orencia] was $53,626,257, covering 1,749 beneficiaries. The average spend per beneficiary was $30,661.10.
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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