Medicare Part D coverage · 0.5 · RxCUI 853350
0.5 ML ustekinumab 90 MG/ML Prefilled Syringe
Per the CMS 2026 Part D formulary file, 0.5 ML ustekinumab 90 MG/ML Prefilled Syringe is covered by 3,238 Medicare Part D plans (64.1% of enrollable products), averaging Tier 4.3, with prior authorization required on 98.2% of covering formularies.
- 64.1%
- Plan coverage
- 3,238
- Plans covering
- T4.3
- Avg tier
- 98.2%
- Prior auth required
What the CMS Formulary Data Shows for 0.5 ML ustekinumab 90 MG/ML Prefilled Syringe
Per the CMS 2026 Part D formulary file, 0.5 ML ustekinumab 90 MG/ML Prefilled Syringe (RxNorm concept RXCUI 853350, generic name 0.5) appears on 163 distinct formulary files spanning 3,238 Medicare Part D plan offerings - 64.1% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.3.
Real-world access to 0.5 ML ustekinumab 90 MG/ML Prefilled Syringe depends on utilization management as much as tier placement: 98.2% of covering formularies require prior authorization. 0.6% require step therapy. 90.8% 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 0.5 ML ustekinumab 90 MG/ML Prefilled Syringe today.
Coverage Details
- Formularies covering
- 163
- Plans covering
- 3,238
- Coverage rate
- 64.1%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 98.2% of formularies
- Step therapy required
- 0.6% of formularies
- Quantity limits
- 90.8% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 0.5 ML ustekinumab 90 MG/ML Prefilled Syringe
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 |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | Yes | $0 | NY |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| 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 |
Show the next 30 plans
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | 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 Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $0 | MO |
| 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 |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | Yes | $0 | CA |
| 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 |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | Yes | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $0 | DE |
| 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 |
| Florida Complete Care (HMO I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | Hpmp 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 |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $13.10 | PA |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Illinois | T1 | Yes | $15.20 | IL |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $17.60 | PA |
| Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $22.70 | NY |
| VIVA Medicare Extra Value (HMO D-SNP) | Viva Health, Inc. | T1 | Yes | $27.70 | AL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 0.5 ML ustekinumab 90 MG/ML Prefilled Syringe covered by Medicare Part D?
Yes, 0.5 ML ustekinumab 90 MG/ML Prefilled Syringe is covered by 3,238 Medicare Part D plans (64.1% of all Part D formularies).
What tier is 0.5 ML ustekinumab 90 MG/ML Prefilled Syringe on Medicare Part D plans?
0.5 ML ustekinumab 90 MG/ML Prefilled Syringe averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 5.
Does 0.5 ML ustekinumab 90 MG/ML Prefilled Syringe require prior authorization?
98.2% of Part D formularies require prior authorization for 0.5 ML ustekinumab 90 MG/ML Prefilled Syringe. Step therapy: 0.6%. Quantity limits: 90.8%.
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
- {4 (selinexor 80 MG Oral Tablet [Xpovio]) } Pack [Xpovio 80 MG Once Weekly Carton-80 MG Tablet] T4.3
- 3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega] T4.3
- 5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega] T4.3
- ceftaroline fosamil 600 MG Injection T4.3
- 1 ML ustekinumab 90 MG/ML Prefilled Syringe T4.3
- sofosbuvir 200 MG / velpatasvir 50 MG Oral Tablet [Epclusa] T4.3
Similar prior-authorization rate
- rimegepant 75 MG Disintegrating Oral Tablet [Nurtec] 98.2% PA
- 1 ML ustekinumab-kfce 90 MG/ML Prefilled Syringe [Yesintek] 98.2% PA
- 2 ML tralokinumab-ldrm 150 MG/ML Auto-Injector [Adbry] 98.2% PA
- fecal microbiota spores, live-brpk 30000000 UNT Oral Capsule [Vowst] 98.2% PA
- relugolix 120 MG Oral Tablet [Orgovyx] 98.2% PA
- nemolizumab-ilto 30 MG Auto-Injector [Nemluvio] 98.3% PA