Medicare Part D coverage · 0.5 · RxCUI 829989
0.5 ML acellular pertussis vaccine, inactivated 0.116 MG/ML / diphtheria toxoid vaccine, inactivated 50 UNT/ML / hepatitis B surface antigen vaccine 0.02 MG/ML / poliovirus vaccine inactivated, type 1 (Mahoney) 80 UNT/ML / poliovirus vaccine inactivated, type 2 (MEF-1) 16 UNT/ML / poliovirus vaccine inactivated, type 3 (Saukett) 64 UNT/ML / tetanus toxoid vaccine, inactivated 20 UNT/ML Prefilled Syringe [PEDIARIX]
Per the CMS 2026 Part D formulary file, 0.5 ML acellular pertussis vaccine, inactivated 0.116 MG/ML / diphtheria toxoid vaccine, inactivated 50 UNT/ML / hepatitis B surface antigen vaccine 0.02 MG/ML / poliovirus vaccine inactivated, type 1 (Mahoney) 80 UNT/ML / poliovirus vaccine inactivated, type 2 (MEF-1) 16 UNT/ML / poliovirus vaccine inactivated, type 3 (Saukett) 64 UNT/ML / tetanus toxoid vaccine, inactivated 20 UNT/ML Prefilled Syringe [PEDIARIX] is covered by 5,052 Medicare Part D plans (100% of enrollable products), averaging Tier 2.3, with prior authorization required on 0% of covering formularies.
- 100%
- Plan coverage
- 5,052
- Plans covering
- T2.3
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for 0.5 ML acellular pertussis vaccine, inactivated 0.116 MG/ML / diphtheria toxoid vaccine, inactivated 50 UNT/ML / hepatitis B surface antigen vaccine 0.02 MG/ML / poliovirus vaccine inactivated, type 1 (Mahoney) 80 UNT/ML / poliovirus vaccine inactivated, type 2 (MEF-1) 16 UNT/ML / poliovirus vaccine inactivated, type 3 (Saukett) 64 UNT/ML / tetanus toxoid vaccine, inactivated 20 UNT/ML Prefilled Syringe [PEDIARIX]
Per the CMS 2026 Part D formulary file, 0.5 ML acellular pertussis vaccine, inactivated 0.116 MG/ML / diphtheria toxoid vaccine, inactivated 50 UNT/ML / hepatitis B surface antigen vaccine 0.02 MG/ML / poliovirus vaccine inactivated, type 1 (Mahoney) 80 UNT/ML / poliovirus vaccine inactivated, type 2 (MEF-1) 16 UNT/ML / poliovirus vaccine inactivated, type 3 (Saukett) 64 UNT/ML / tetanus toxoid vaccine, inactivated 20 UNT/ML Prefilled Syringe [PEDIARIX] (RxNorm concept RXCUI 829989, 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 2.3.
Real-world access to 0.5 ML acellular pertussis vaccine, inactivated 0.116 MG/ML / diphtheria toxoid vaccine, inactivated 50 UNT/ML / hepatitis B surface antigen vaccine 0.02 MG/ML / poliovirus vaccine inactivated, type 1 (Mahoney) 80 UNT/ML / poliovirus vaccine inactivated, type 2 (MEF-1) 16 UNT/ML / poliovirus vaccine inactivated, type 3 (Saukett) 64 UNT/ML / tetanus toxoid vaccine, inactivated 20 UNT/ML Prefilled Syringe [PEDIARIX] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 1.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 90 Part D beneficiaries filled 0.5 ML acellular pertussis vaccine, inactivated 0.116 MG/ML / diphtheria toxoid vaccine, inactivated 50 UNT/ML / hepatitis B surface antigen vaccine 0.02 MG/ML / poliovirus vaccine inactivated, type 1 (Mahoney) 80 UNT/ML / poliovirus vaccine inactivated, type 2 (MEF-1) 16 UNT/ML / poliovirus vaccine inactivated, type 3 (Saukett) 64 UNT/ML / tetanus toxoid vaccine, inactivated 20 UNT/ML Prefilled Syringe [PEDIARIX] in 2023, with total plan-and-beneficiary spending of $15,982 and an average per-beneficiary annual cost of $177.58. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 0.5 ML acellular pertussis vaccine, inactivated 0.116 MG/ML / diphtheria toxoid vaccine, inactivated 50 UNT/ML / hepatitis B surface antigen vaccine 0.02 MG/ML / poliovirus vaccine inactivated, type 1 (Mahoney) 80 UNT/ML / poliovirus vaccine inactivated, type 2 (MEF-1) 16 UNT/ML / poliovirus vaccine inactivated, type 3 (Saukett) 64 UNT/ML / tetanus toxoid vaccine, inactivated 20 UNT/ML Prefilled Syringe [PEDIARIX] 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
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 1.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 90
- Total spending
- $15,982
- Avg per beneficiary
- $177.58
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 0.5 ML acellular pertussis vaccine, inactivated 0.116 MG/ML / diphtheria toxoid vaccine, inactivated 50 UNT/ML / hepatitis B surface antigen vaccine 0.02 MG/ML / poliovirus vaccine inactivated, type 1 (Mahoney) 80 UNT/ML / poliovirus vaccine inactivated, type 2 (MEF-1) 16 UNT/ML / poliovirus vaccine inactivated, type 3 (Saukett) 64 UNT/ML / tetanus toxoid vaccine, inactivated 20 UNT/ML Prefilled Syringe [PEDIARIX]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Aetna Medicare Signature (HMO) | Aetna Health OF California Inc. | T1 | No | $0 | CA |
| Aetna Medicare Signature (HMO) | Aetna Health OF California Inc. | T1 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO-POS) | Aetna Health OF California Inc. | T1 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | Aetna Health OF California Inc. | T1 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | Aetna Health OF California Inc. | T1 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | Aetna Health OF California Inc. | T1 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO) | Aetna Health OF California Inc. | T1 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | Aetna Health OF California Inc. | T1 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO) | Aetna Health OF California Inc. | T1 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO) | Aetna Health OF California Inc. | T1 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO) | Aetna Health OF California Inc. | T1 | No | $0 | CA |
| Aetna Medicare Signature Care (HMO-POS) | Aetna Health OF Ohio Inc. | T1 | No | $0 | OH |
| Aetna Medicare Signature Extra (HMO-POS) | Aetna Health OF Ohio Inc. | T1 | No | $0 | OH |
| Aetna Medicare Signature Care (HMO-POS) | Aetna Health OF Ohio Inc. | T1 | No | $0 | OH |
| Aetna Medicare Signature Extra (HMO-POS) | Aetna Health OF Ohio Inc. | T1 | No | $0 | KY |
| Aetna Medicare Signature (HMO-POS) | Aetna Health OF Ohio Inc. | T1 | No | $0 | KY |
| Aetna Medicare Signature (HMO-POS) | Aetna Health OF Ohio Inc. | T1 | No | $0 | KY |
| Aetna Medicare HIDE (HMO D-SNP) | Aetna Health OF Ohio Inc. | T1 | No | $0 | KY |
| Aetna Medicare Dual Care (HMO D-SNP) | Aetna Health OF Ohio Inc. | T1 | No | $0 | OH |
| Aetna Medicare Signature Care (HMO-POS) | Aetna Health OF Ohio Inc. | T1 | No | $0 | OH |
Show the next 30 plans
| Aetna Medicare Signature (HMO-POS) | Aetna Health OF Ohio Inc. | T1 | No | $0 | OH |
| Aetna Medicare Signature (HMO-POS) | Aetna Health OF Ohio Inc. | T1 | No | $0 | KY |
| Aetna Medicare Partial Dual (HMO D-SNP) | Aetna Health OF Ohio Inc. | T1 | No | $0 | KY |
| Aetna Medicare Partial Dual (HMO D-SNP) | Aetna Health OF Ohio Inc. | T1 | No | $0 | OH |
| Aetna Medicare Signature (HMO) | Aetna Health Inc. (GA) | T1 | No | $0 | GA |
| Aetna Medicare Signature (HMO-POS) | Coventry Health Care OF Illinois, Inc. | T1 | No | $0 | WI |
| Aetna Medicare Signature (HMO-POS) | Coventry Health Care OF Illinois, Inc. | T1 | No | $0 | IL |
| Aetna Medicare Prime Chronic Care (HMO C-SNP) | Coventry Health Care OF Illinois, Inc. | T1 | No | $0 | IL |
| Aetna Medicare Signature Extra (HMO-POS) | Coventry Health Care OF Illinois, Inc. | T1 | No | $0 | IL |
| Aetna Medicare Signature (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | IA |
| Aetna Medicare Signature (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | NE |
| Aetna Medicare Signature (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | KS, MO |
| Aetna Medicare Signature Extra (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | KS |
| Aetna Medicare Signature (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | KS, MO |
| Aetna Medicare Signature Plus (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | AR |
| Aetna Medicare Signature (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | KS |
| Aetna Medicare Advantra (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | OH |
| Aetna Medicare Advantra Signature Giveback (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | WV |
| Aetna Medicare Elite (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | IA |
| Aetna Medicare Signature Extra (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | NE |
| Aetna Medicare Advantra Signature (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | WV |
| Aetna Medicare Elite (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | IL, MO |
| Aetna Medicare Signature (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | MO |
| Aetna Medicare Elite (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | KS, MO |
| Aetna Medicare Elite (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | AR |
| Aetna Medicare Dual (PPO D-SNP) | Coventry Health AND Life Insurance Company | T1 | No | $0 | SD |
| Aetna Medicare Signature (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | MO |
| Aetna Medicare Signature (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | KS |
| Aetna Medicare Signature (PPO) | Coventry Health AND Life Insurance Company | T1 | No | $0 | KS |
| Aetna Medicare Dual Extra (PPO D-SNP) | Coventry Health AND Life Insurance Company | T1 | No | $0 | AR |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 0.5 ML acellular pertussis vaccine, inactivated 0.116 MG/ML / diphtheria toxoid vaccine, inactivated 50 UNT/ML / hepatitis B surface antigen vaccine 0.02 MG/ML / poliovirus vaccine inactivated, type 1 (Mahoney) 80 UNT/ML / poliovirus vaccine inactivated, type 2 (MEF-1) 16 UNT/ML / poliovirus vaccine inactivated, type 3 (Saukett) 64 UNT/ML / tetanus toxoid vaccine, inactivated 20 UNT/ML Prefilled Syringe [PEDIARIX] covered by Medicare Part D?
Yes, 0.5 ML acellular pertussis vaccine, inactivated 0.116 MG/ML / diphtheria toxoid vaccine, inactivated 50 UNT/ML / hepatitis B surface antigen vaccine 0.02 MG/ML / poliovirus vaccine inactivated, type 1 (Mahoney) 80 UNT/ML / poliovirus vaccine inactivated, type 2 (MEF-1) 16 UNT/ML / poliovirus vaccine inactivated, type 3 (Saukett) 64 UNT/ML / tetanus toxoid vaccine, inactivated 20 UNT/ML Prefilled Syringe [PEDIARIX] is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).
What tier is 0.5 ML acellular pertussis vaccine, inactivated 0.116 MG/ML / diphtheria toxoid vaccine, inactivated 50 UNT/ML / hepatitis B surface antigen vaccine 0.02 MG/ML / poliovirus vaccine inactivated, type 1 (Mahoney) 80 UNT/ML / poliovirus vaccine inactivated, type 2 (MEF-1) 16 UNT/ML / poliovirus vaccine inactivated, type 3 (Saukett) 64 UNT/ML / tetanus toxoid vaccine, inactivated 20 UNT/ML Prefilled Syringe [PEDIARIX] on Medicare Part D plans?
0.5 ML acellular pertussis vaccine, inactivated 0.116 MG/ML / diphtheria toxoid vaccine, inactivated 50 UNT/ML / hepatitis B surface antigen vaccine 0.02 MG/ML / poliovirus vaccine inactivated, type 1 (Mahoney) 80 UNT/ML / poliovirus vaccine inactivated, type 2 (MEF-1) 16 UNT/ML / poliovirus vaccine inactivated, type 3 (Saukett) 64 UNT/ML / tetanus toxoid vaccine, inactivated 20 UNT/ML Prefilled Syringe [PEDIARIX] averages Tier 2.3 across Part D plans, ranging from Tier 1 to Tier 6.
Does 0.5 ML acellular pertussis vaccine, inactivated 0.116 MG/ML / diphtheria toxoid vaccine, inactivated 50 UNT/ML / hepatitis B surface antigen vaccine 0.02 MG/ML / poliovirus vaccine inactivated, type 1 (Mahoney) 80 UNT/ML / poliovirus vaccine inactivated, type 2 (MEF-1) 16 UNT/ML / poliovirus vaccine inactivated, type 3 (Saukett) 64 UNT/ML / tetanus toxoid vaccine, inactivated 20 UNT/ML Prefilled Syringe [PEDIARIX] require prior authorization?
0% of Part D formularies require prior authorization for 0.5 ML acellular pertussis vaccine, inactivated 0.116 MG/ML / diphtheria toxoid vaccine, inactivated 50 UNT/ML / hepatitis B surface antigen vaccine 0.02 MG/ML / poliovirus vaccine inactivated, type 1 (Mahoney) 80 UNT/ML / poliovirus vaccine inactivated, type 2 (MEF-1) 16 UNT/ML / poliovirus vaccine inactivated, type 3 (Saukett) 64 UNT/ML / tetanus toxoid vaccine, inactivated 20 UNT/ML Prefilled Syringe [PEDIARIX]. Step therapy: 0%. Quantity limits: 1.5%.
How much does Medicare spend on 0.5 ML acellular pertussis vaccine, inactivated 0.116 MG/ML / diphtheria toxoid vaccine, inactivated 50 UNT/ML / hepatitis B surface antigen vaccine 0.02 MG/ML / poliovirus vaccine inactivated, type 1 (Mahoney) 80 UNT/ML / poliovirus vaccine inactivated, type 2 (MEF-1) 16 UNT/ML / poliovirus vaccine inactivated, type 3 (Saukett) 64 UNT/ML / tetanus toxoid vaccine, inactivated 20 UNT/ML Prefilled Syringe [PEDIARIX]?
In 2023, total Medicare Part D spending on 0.5 ML acellular pertussis vaccine, inactivated 0.116 MG/ML / diphtheria toxoid vaccine, inactivated 50 UNT/ML / hepatitis B surface antigen vaccine 0.02 MG/ML / poliovirus vaccine inactivated, type 1 (Mahoney) 80 UNT/ML / poliovirus vaccine inactivated, type 2 (MEF-1) 16 UNT/ML / poliovirus vaccine inactivated, type 3 (Saukett) 64 UNT/ML / tetanus toxoid vaccine, inactivated 20 UNT/ML Prefilled Syringe [PEDIARIX] was $15,982, covering 90 beneficiaries. The average spend per beneficiary was $177.58.
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
- 0.25 ML tick-borne encephalitis purified antigen 0.0048 MG/ML Prefilled Syringe [Ticovac] T2.3
- acetaminophen 325 MG / oxycodone hydrochloride 5 MG Oral Tablet T2.3
- sodium polystyrene sulfonate 15000 MG Powder for Oral Suspension T2.3
- oxycodone hydrochloride 30 MG Oral Tablet T2.3
- fosinopril sodium 10 MG Oral Tablet T2.3
- amlodipine 10 MG / valsartan 160 MG Oral Tablet T2.3
Similar prior-authorization rate
- metronidazole 10 MG/ML Topical Cream [Noritate] 0% PA
- 24 HR minocycline 40 MG Extended Release Oral Capsule [Emrosi] 0% PA
- buspirone hydrochloride 10 MG Oral Capsule [Bucapsol] 0% PA
- diflunisal 375 MG Oral Tablet [Dolobid] 0% PA
- hydrocortisone 1 MG/ML Oral Solution [Khindivi] 0% PA
- indomethacin 50 MG Rectal Suppository [Indocin] 0% PA