Medicare Part D coverage · 0.5 · RxCUI 2642148
0.5 ML respiratory syncytial virus pre-fusion F protein, A, recombinant, stabilized 0.12 MG/ML / respiratory syncytial virus pre-fusion F protein, B, recombinant, stabilized 0.12 MG/ML Injection [Abrysvo]
Per the CMS 2026 Part D formulary file, 0.5 ML respiratory syncytial virus pre-fusion F protein, A, recombinant, stabilized 0.12 MG/ML / respiratory syncytial virus pre-fusion F protein, B, recombinant, stabilized 0.12 MG/ML Injection [Abrysvo] is covered by 5,052 Medicare Part D plans (100% of enrollable products), averaging Tier 2.2, with prior authorization required on 21% of covering formularies.
- 100%
- Plan coverage
- 5,052
- Plans covering
- T2.2
- Avg tier
- 21%
- Prior auth required
What the CMS Formulary Data Shows for 0.5 ML respiratory syncytial virus pre-fusion F protein, A, recombinant, stabilized 0.12 MG/ML / respiratory syncytial virus pre-fusion F protein, B, recombinant, stabilized 0.12 MG/ML Injection [Abrysvo]
Per the CMS 2026 Part D formulary file, 0.5 ML respiratory syncytial virus pre-fusion F protein, A, recombinant, stabilized 0.12 MG/ML / respiratory syncytial virus pre-fusion F protein, B, recombinant, stabilized 0.12 MG/ML Injection [Abrysvo] (RxNorm concept RXCUI 2642148, generic name 0.5) appears on 328 distinct formulary files spanning 5,052 Medicare Part D plan offerings - 100% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 2.2.
Real-world access to 0.5 ML respiratory syncytial virus pre-fusion F protein, A, recombinant, stabilized 0.12 MG/ML / respiratory syncytial virus pre-fusion F protein, B, recombinant, stabilized 0.12 MG/ML Injection [Abrysvo] depends on utilization management as much as tier placement: 21% of covering formularies require prior authorization. 0% require step therapy. 40.9% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 2,131,906 Part D beneficiaries filled 0.5 ML respiratory syncytial virus pre-fusion F protein, A, recombinant, stabilized 0.12 MG/ML / respiratory syncytial virus pre-fusion F protein, B, recombinant, stabilized 0.12 MG/ML Injection [Abrysvo] in 2023, with total plan-and-beneficiary spending of $698,160,178 and an average per-beneficiary annual cost of $327.48. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 0.5 ML respiratory syncytial virus pre-fusion F protein, A, recombinant, stabilized 0.12 MG/ML / respiratory syncytial virus pre-fusion F protein, B, recombinant, stabilized 0.12 MG/ML Injection [Abrysvo] today.
Coverage Details
- Formularies covering
- 328
- Plans covering
- 5,052
- Coverage rate
- 100%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 21% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 40.9% of formularies
2023 Medicare Spending
- Beneficiaries
- 2,131,906
- Total spending
- $698,160,178
- Avg per beneficiary
- $327.48
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 0.5 ML respiratory syncytial virus pre-fusion F protein, A, recombinant, stabilized 0.12 MG/ML / respiratory syncytial virus pre-fusion F protein, B, recombinant, stabilized 0.12 MG/ML Injection [Abrysvo]
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 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| Wellpoint Medicare Advantage (HMO-POS) | Wellpoint West Virginia , Inc. | T1 | No | $0 | WV |
| Anthem Medicare Advantage 3 (HMO-POS) | Healthkeepers, Inc. | T1 | No | $0 | VA |
| Anthem Medicare Advantage 3 (HMO-POS) | Healthkeepers, Inc. | T1 | No | $0 | VA |
| Anthem Medicare Advantage 3 (HMO-POS) | Healthkeepers, Inc. | T1 | No | $0 | VA |
| Wellpoint Medicare Advantage 2 (HMO-POS) | Wellpoint Tennessee, Inc. | T1 | No | $0 | TN |
| Wellpoint Medicare Advantage 2 (HMO-POS) | Wellpoint Tennessee, Inc. | T1 | No | $0 | TN |
| Wellpoint Medicare Advantage 2 (HMO-POS) | Wellpoint Tennessee, Inc. | T1 | No | $0 | TN |
| Wellpoint Medicare Advantage 2 (HMO-POS) | Wellpoint Tennessee, Inc. | T1 | No | $0 | TN |
| Anthem Select (HMO-POS) | Blue Cross OF California | T1 | No | $0 | CA |
| Anthem Medicare Advantage (HMO-POS) | Blue Cross OF California | T1 | No | $0 | CA |
| Anthem Medicare Advantage (HMO-POS) | Blue Cross OF California | T1 | No | $0 | CA |
| Anthem Medicare Advantage (HMO-POS) | Blue Cross OF California | T1 | No | $0 | CA |
| Anthem Select (HMO-POS) | Blue Cross OF California | T1 | No | $0 | CA |
| Anthem Select (HMO-POS) | Blue Cross OF California | T1 | No | $0 | CA |
| Anthem Select (HMO-POS) | Blue Cross OF California | T1 | No | $0 | CA |
| Anthem Medicare Advantage (HMO-POS) | Blue Cross OF California | T1 | No | $0 | CA |
| Anthem Select (HMO-POS) | Blue Cross OF California | T1 | No | $0 | CA |
| Anthem Medicare Advantage (HMO-POS) | Blue Cross OF California | T1 | No | $0 | CA |
Show the next 30 plans
| Wellpoint Medicare Advantage (HMO-POS) | Wellpoint Health Plans, Inc. | T1 | No | $0 | AZ |
| Anthem Prime (HMO-POS) | Blue Cross OF California Partnership Plan, Inc. | T1 | No | $0 | CA |
| Anthem Prime (HMO-POS) | Blue Cross OF California Partnership Plan, Inc. | T1 | No | $0 | CA |
| Anthem Prime (HMO-POS) | Blue Cross OF California Partnership Plan, Inc. | T1 | No | $0 | CA |
| Anthem Prime (HMO-POS) | Blue Cross OF California Partnership Plan, Inc. | T1 | No | $0 | CA |
| Anthem Prime (HMO-POS) | Blue Cross OF California Partnership Plan, Inc. | T1 | No | $0 | CA |
| Anthem Prime (HMO-POS) | Blue Cross OF California Partnership Plan, Inc. | T1 | No | $0 | CA |
| Anthem Prime (HMO-POS) | Blue Cross OF California Partnership Plan, Inc. | T1 | No | $0 | CA |
| Anthem Prime (HMO-POS) | Blue Cross OF California Partnership Plan, Inc. | T1 | No | $0 | CA |
| Anthem Medicare Advantage (HMO-POS) | HMO Colorado, Inc. | T1 | No | $0 | NV |
| Anthem Full Dual Advantage (HMO D-SNP) | HMO Colorado, Inc. | T1 | No | $0 | NV |
| Anthem Full Dual Advantage 2 (HMO D-SNP) | HMO Colorado, Inc. | T1 | No | $0 | NV |
| Anthem Full Dual Advantage Aligned (HMO D-SNP) | Blue Cross OF California Partnership Plan, Inc. | T1 | No | $0 | CA |
| Freedom VIP Care (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Savings (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Diamond (HMO C-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Freedom Medi-Medi Partial (HMO D-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Medi-Medi Full (HMO D-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Optimum Emerald Partial (HMO D-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Optimum Emerald Full (HMO D-SNP) | Optimum Healthcare, Inc. | T1 | No | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | Freedom Health, Inc. | T1 | No | $0 | FL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 0.5 ML respiratory syncytial virus pre-fusion F protein, A, recombinant, stabilized 0.12 MG/ML / respiratory syncytial virus pre-fusion F protein, B, recombinant, stabilized 0.12 MG/ML Injection [Abrysvo] covered by Medicare Part D?
Yes, 0.5 ML respiratory syncytial virus pre-fusion F protein, A, recombinant, stabilized 0.12 MG/ML / respiratory syncytial virus pre-fusion F protein, B, recombinant, stabilized 0.12 MG/ML Injection [Abrysvo] is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).
What tier is 0.5 ML respiratory syncytial virus pre-fusion F protein, A, recombinant, stabilized 0.12 MG/ML / respiratory syncytial virus pre-fusion F protein, B, recombinant, stabilized 0.12 MG/ML Injection [Abrysvo] on Medicare Part D plans?
0.5 ML respiratory syncytial virus pre-fusion F protein, A, recombinant, stabilized 0.12 MG/ML / respiratory syncytial virus pre-fusion F protein, B, recombinant, stabilized 0.12 MG/ML Injection [Abrysvo] averages Tier 2.2 across Part D plans, ranging from Tier 1 to Tier 6.
Does 0.5 ML respiratory syncytial virus pre-fusion F protein, A, recombinant, stabilized 0.12 MG/ML / respiratory syncytial virus pre-fusion F protein, B, recombinant, stabilized 0.12 MG/ML Injection [Abrysvo] require prior authorization?
21% of Part D formularies require prior authorization for 0.5 ML respiratory syncytial virus pre-fusion F protein, A, recombinant, stabilized 0.12 MG/ML / respiratory syncytial virus pre-fusion F protein, B, recombinant, stabilized 0.12 MG/ML Injection [Abrysvo]. Step therapy: 0%. Quantity limits: 40.9%.
How much does Medicare spend on 0.5 ML respiratory syncytial virus pre-fusion F protein, A, recombinant, stabilized 0.12 MG/ML / respiratory syncytial virus pre-fusion F protein, B, recombinant, stabilized 0.12 MG/ML Injection [Abrysvo]?
In 2023, total Medicare Part D spending on 0.5 ML respiratory syncytial virus pre-fusion F protein, A, recombinant, stabilized 0.12 MG/ML / respiratory syncytial virus pre-fusion F protein, B, recombinant, stabilized 0.12 MG/ML Injection [Abrysvo] was $698,160,178, covering 2,131,906 beneficiaries. The average spend per beneficiary was $327.48.
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
- linezolid 20 MG/ML Oral Suspension 20.9% PA
- 24 HR topiramate 200 MG Extended Release Oral Capsule 21.1% PA
- 24 HR topiramate 50 MG Extended Release Oral Capsule 21.1% PA
- mercaptopurine 20 MG/ML Oral Suspension 20.7% PA
- 0.14 ML risperidone 357 MG/ML Prefilled Syringe [Uzedy] 21.3% PA
- 0.21 ML risperidone 357 MG/ML Prefilled Syringe [Uzedy] 21.3% PA