Medicare Part D coverage · 0.5 · RxCUI 1546189
0.5 ML peginterferon beta-1a 0.25 MG/ML Prefilled Syringe [Plegridy]
Per the CMS 2026 Part D formulary file, 0.5 ML peginterferon beta-1a 0.25 MG/ML Prefilled Syringe [Plegridy] is covered by 585 Medicare Part D plans (11.6% of enrollable products), averaging Tier 3.9, with prior authorization required on 77.5% of covering formularies.
- 11.6%
- Plan coverage
- 585
- Plans covering
- T3.9
- Avg tier
- 77.5%
- Prior auth required
What the CMS Formulary Data Shows for 0.5 ML peginterferon beta-1a 0.25 MG/ML Prefilled Syringe [Plegridy]
Per the CMS 2026 Part D formulary file, 0.5 ML peginterferon beta-1a 0.25 MG/ML Prefilled Syringe [Plegridy] (RxNorm concept RXCUI 1546189, generic name 0.5) appears on 138 distinct formulary files spanning 585 Medicare Part D plan offerings - 11.6% 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 3.9.
Real-world access to 0.5 ML peginterferon beta-1a 0.25 MG/ML Prefilled Syringe [Plegridy] depends on utilization management as much as tier placement: 77.5% of covering formularies require prior authorization. 0% require step therapy. 97.1% 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 peginterferon beta-1a 0.25 MG/ML Prefilled Syringe [Plegridy] today.
Coverage Details
- Formularies covering
- 138
- Plans covering
- 585
- Coverage rate
- 11.6%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 77.5% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 97.1% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 0.5 ML peginterferon beta-1a 0.25 MG/ML Prefilled Syringe [Plegridy]
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 |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | Yes | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | Yes | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | Yes | $0 | NJ |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | Yes | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | Yes | $0 | GA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | Yes | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | No | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | No | $0 | AL |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | Yes | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | Yes | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | Yes | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $0 | MD |
Show the next 30 plans
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $0 | NY |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $0 | KY, TN |
| 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 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | No | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | No | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | No | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | American Health Plan OF FL, Inc. | T1 | No | $4.80 | FL |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Hcsc Insurance Services Company | T1 | Yes | $4.80 | TX |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS Insurance Company | T1 | Yes | $5.00 | OK |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | Yes | $8.80 | MI |
| Senior Care (HMO I-SNP) | Align Senior Care MI, LLC | T1 | No | $8.80 | MI |
| AgeRight Advantage Health Plan (HMO I-SNP) | Marquis Advantage, Inc. | T1 | No | $10.50 | OR, WA |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| Senior Care (HMO I-SNP) | Align Senior Care California Inc. | T1 | No | $12.00 | CA |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $13.10 | PA |
| Liberty Medicare Dual Plan (HMO D-SNP) | Liberty Advantage, LLC | T1 | No | $14.70 | NC |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Illinois, Inc. | T1 | Yes | $15.20 | IL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | Yes | $17.00 | AZ |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 0.5 ML peginterferon beta-1a 0.25 MG/ML Prefilled Syringe [Plegridy] covered by Medicare Part D?
Yes, 0.5 ML peginterferon beta-1a 0.25 MG/ML Prefilled Syringe [Plegridy] is covered by 585 Medicare Part D plans (11.6% of all Part D formularies).
What tier is 0.5 ML peginterferon beta-1a 0.25 MG/ML Prefilled Syringe [Plegridy] on Medicare Part D plans?
0.5 ML peginterferon beta-1a 0.25 MG/ML Prefilled Syringe [Plegridy] averages Tier 3.9 across Part D plans, ranging from Tier 1 to Tier 5.
Does 0.5 ML peginterferon beta-1a 0.25 MG/ML Prefilled Syringe [Plegridy] require prior authorization?
77.5% of Part D formularies require prior authorization for 0.5 ML peginterferon beta-1a 0.25 MG/ML Prefilled Syringe [Plegridy]. Step therapy: 0%. Quantity limits: 97.1%.
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
- fosamprenavir 700 MG Oral Tablet T3.9
- perampanel 0.5 MG/ML Oral Suspension T3.9
- 0.8 ML fondaparinux sodium 12.5 MG/ML Prefilled Syringe T3.9
- roflumilast 1.5 MG/ML Topical Cream [Zoryve] T3.9
- 0.6 ML pegfilgrastim-apgf 10 MG/ML Prefilled Syringe [Nyvepria] T3.9
- 12 HR zileuton 600 MG Extended Release Oral Tablet T3.9
Similar prior-authorization rate
- 1.5 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron] 77.5% PA
- vigabatrin 500 MG Oral Tablet 77.4% PA
- {14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule) } Pack 77.7% PA
- vigabatrin 500 MG Powder for Oral Solution 77.7% PA
- ruxolitinib 15 MG/ML Topical Cream [Opzelura] 77.8% PA
- deferiprone 100 MG/ML Oral Solution [Ferriprox] 77.8% PA