Medicare Part D coverage · 0.5 · RxCUI 2046370
0.5 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq]
Per the CMS 2026 Part D formulary file, 0.5 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] is covered by 198 Medicare Part D plans (3.9% of enrollable products), averaging Tier 4.1, with prior authorization required on 95.5% of covering formularies.
- 3.9%
- Plan coverage
- 198
- Plans covering
- T4.1
- Avg tier
- 95.5%
- Prior auth required
What the CMS Formulary Data Shows for 0.5 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq]
Per the CMS 2026 Part D formulary file, 0.5 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] (RxNorm concept RXCUI 2046370, generic name 0.5) appears on 22 distinct formulary files spanning 198 Medicare Part D plan offerings - 3.9% 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 4.1.
Real-world access to 0.5 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] depends on utilization management as much as tier placement: 95.5% of covering formularies require prior authorization. 0% require step therapy. 18.2% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 91 Part D beneficiaries filled 0.5 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] in 2023, with total plan-and-beneficiary spending of $20,307,239 and an average per-beneficiary annual cost of $223,156.47. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 0.5 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] today.
Coverage Details
- Formularies covering
- 22
- Plans covering
- 198
- Coverage rate
- 3.9%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 95.5% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 18.2% of formularies
2023 Medicare Spending
- Beneficiaries
- 91
- Total spending
- $20,307,239
- Avg per beneficiary
- $223,156.47
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 0.5 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq]
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 |
| 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 |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | Yes | $17.00 | AZ |
| 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 |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T4 | Yes | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T4 | Yes | $0 | NY |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS Choice | T4 | Yes | $51.60 | NY |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | Selecthealth, Inc. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | UT |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | NV |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | CO |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | CO |
| Select Health Medicare Flex (HMO) | Selecthealth, Inc. | T5 | Yes | $0 | CO |
Show the next 30 plans
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 0.5 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] covered by Medicare Part D?
Yes, 0.5 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] is covered by 198 Medicare Part D plans (3.9% of all Part D formularies).
What tier is 0.5 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] on Medicare Part D plans?
0.5 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] averages Tier 4.1 across Part D plans, ranging from Tier 1 to Tier 5.
Does 0.5 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] require prior authorization?
95.5% of Part D formularies require prior authorization for 0.5 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq]. Step therapy: 0%. Quantity limits: 18.2%.
How much does Medicare spend on 0.5 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq]?
In 2023, total Medicare Part D spending on 0.5 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] was $20,307,239, covering 91 beneficiaries. The average spend per beneficiary was $223,156.47.
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
- sodium phenylbutyrate 0.94 MG/MG Oral Powder T4.1
- 1 ML filgrastim-aafi 0.3 MG/ML Injection [Nivestym] T4.1
- 1.6 ML filgrastim-aafi 0.3 MG/ML Injection [Nivestym] T4.1
- 0.2 ML adalimumab-ryvk 100 MG/ML Prefilled Syringe [Simlandi] T4.1
- 0.4 ML adalimumab-ryvk 100 MG/ML Auto-Injector [Simlandi] T4.1
- 0.8 ML adalimumab-ryvk 100 MG/ML Auto-Injector [Simlandi] T4.1
Similar prior-authorization rate
- fezolinetant 45 MG Oral Tablet [Veozah] 95.5% PA
- fostamatinib 100 MG Oral Tablet [Tavalisse] 95.5% PA
- 1 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] 95.5% PA
- sapropterin dihydrochloride 500 MG Powder for Oral Solution 95.6% PA
- lidocaine 0.05 MG/MG Medicated Patch [Lidocan] 95.2% PA
- maralixibat 10 MG Oral Tablet [Livmarli] 95.2% PA