0.5 ML corticotropin 80 UNT/ML Prefilled Syringe [Acthar]
corticotropin
RxCUI: 2685299
What the CMS Formulary Data Shows for 0.5 ML corticotropin 80 UNT/ML Prefilled Syringe [Acthar]
Per the CMS 2026 Part D formulary file, 0.5 ML corticotropin 80 UNT/ML Prefilled Syringe [Acthar] (RxNorm concept RXCUI 2685299, generic name corticotropin) appears on 12 distinct formulary files spanning 145 Medicare Part D plan offerings - 2.9% 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 4.4.
Real-world access to 0.5 ML corticotropin 80 UNT/ML Prefilled Syringe [Acthar] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 942 Part D beneficiaries filled 0.5 ML corticotropin 80 UNT/ML Prefilled Syringe [Acthar] in 2023, with total plan-and-beneficiary spending of $377,839,859 and an average per-beneficiary annual cost of $401,103.88. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 0.5 ML corticotropin 80 UNT/ML Prefilled Syringe [Acthar] today.
Coverage Details
- Formularies covering
- 12
- Plans covering
- 145
- Coverage rate
- 2.9%
- 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
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 942
- Total spending
- $377,839,859
- Avg per beneficiary
- $401,103.88
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 0.5 ML corticotropin 80 UNT/ML Prefilled Syringe [Acthar]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $0 | NY |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $34.50 | NY |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| Medicare BlueEssential (PPO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| Medicare BlueActive (PPO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| Medicare BlueVital (PPO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| Univera SeniorChoice Basic (HMO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| Univera SeniorChoice Extra (HMO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| Medicare Blue Choice Core (HMO) | EXCELLUS HEALTH PLAN, INC. | T5 | Yes | $0 | NY |
| Univera Medicare Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T5 | Yes | $0 | NY |
| Medicare Blue Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T5 | Yes | $0 | NY |
| Alignment Health the ONE + Walgreens (HMO) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | Yes | $0 | AZ |
| Alignment Health the ONE + Walgreens (HMO) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | Yes | $0 | AZ |
| Alignment Health Heart & Diabetes (HMO C-SNP) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | Yes | $0 | AZ |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | Yes | $0 | AZ |
| Alignment Health My Choice (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Platinum + Instacart (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Heart & Diabetes (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health AllCare Preferred (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Platinum + Instacart (HMO-POS) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health My Choice (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Harmony (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Balance (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health the ONE (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health the ONE + Walgreens (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health CommUnity (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health smartSavings (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health My Choice Select (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health My Choice CalCare (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Honor+ Plan (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health ValorCare (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health L.A. Premium Giveback (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health S.D. Premium Giveback (HMO) | ALIGNMENT HEALTH PLAN | T5 | Yes | $0 | CA |
| Alignment Health Platinum (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| Alignment Health NC Duals (HMO-POS D-SNP) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| Alignment Health Platinum + Instacart (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NV |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NV |
| Alignment Health Platinum Select (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| Alignment Health the ONE + Walgreens (HMO-POS) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $0 | TX |
| Alignment Health Heart & Diabetes (HMO-POS C-SNP) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $0 | TX |
| Alignment Health smartHMO (HMO-POS) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $0 | TX |
| Alignment Health Dual Select+ (HMO-POS D-SNP) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $0 | TX |
| Alignment Health Total Dual+ (HMO-POS D-SNP) | ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC | T5 | Yes | $0 | TX |
Frequently Asked Questions
Is 0.5 ML corticotropin 80 UNT/ML Prefilled Syringe [Acthar] covered by Medicare Part D?
Yes, 0.5 ML corticotropin 80 UNT/ML Prefilled Syringe [Acthar] is covered by 145 Medicare Part D plans (2.9% of all Part D formularies).
What tier is 0.5 ML corticotropin 80 UNT/ML Prefilled Syringe [Acthar] on Medicare Part D plans?
0.5 ML corticotropin 80 UNT/ML Prefilled Syringe [Acthar] averages Tier 4.4 across Part D plans, ranging from Tier 1 to Tier 5.
Does 0.5 ML corticotropin 80 UNT/ML Prefilled Syringe [Acthar] require prior authorization?
100% of Part D formularies require prior authorization for 0.5 ML corticotropin 80 UNT/ML Prefilled Syringe [Acthar]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on 0.5 ML corticotropin 80 UNT/ML Prefilled Syringe [Acthar]?
In 2023, total Medicare Part D spending on 0.5 ML corticotropin 80 UNT/ML Prefilled Syringe [Acthar] was $377,839,859, covering 942 beneficiaries. The average spend per beneficiary was $401,103.88.
Read our methodology - how this data is sourced, computed, and verified.