Medicare Part D coverage · 0.6 · RxCUI 2048025
0.6 ML pegfilgrastim-jmdb 10 MG/ML Prefilled Syringe [Fulphila]
Per the CMS 2026 Part D formulary file, 0.6 ML pegfilgrastim-jmdb 10 MG/ML Prefilled Syringe [Fulphila] is covered by 1,885 Medicare Part D plans (37.3% of enrollable products), averaging Tier 4.1, with prior authorization required on 79.9% of covering formularies.
- 37.3%
- Plan coverage
- 1,885
- Plans covering
- T4.1
- Avg tier
- 79.9%
- Prior auth required
What the CMS Formulary Data Shows for 0.6 ML pegfilgrastim-jmdb 10 MG/ML Prefilled Syringe [Fulphila]
Per the CMS 2026 Part D formulary file, 0.6 ML pegfilgrastim-jmdb 10 MG/ML Prefilled Syringe [Fulphila] (RxNorm concept RXCUI 2048025, generic name 0.6) appears on 179 distinct formulary files spanning 1,885 Medicare Part D plan offerings - 37.3% 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 0.6 ML pegfilgrastim-jmdb 10 MG/ML Prefilled Syringe [Fulphila] depends on utilization management as much as tier placement: 79.9% of covering formularies require prior authorization. 0.6% require step therapy. 33% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 173 Part D beneficiaries filled 0.6 ML pegfilgrastim-jmdb 10 MG/ML Prefilled Syringe [Fulphila] in 2023, with total plan-and-beneficiary spending of $624,238 and an average per-beneficiary annual cost of $3,608.31. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 0.6 ML pegfilgrastim-jmdb 10 MG/ML Prefilled Syringe [Fulphila] today.
Coverage Details
- Formularies covering
- 179
- Plans covering
- 1,885
- Coverage rate
- 37.3%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 79.9% of formularies
- Step therapy required
- 0.6% of formularies
- Quantity limits
- 33% of formularies
2023 Medicare Spending
- Beneficiaries
- 173
- Total spending
- $624,238
- Avg per beneficiary
- $3,608.31
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 0.6 ML pegfilgrastim-jmdb 10 MG/ML Prefilled Syringe [Fulphila]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| 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 |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | Yes | $0 | NY |
| 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 |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| 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 |
Show the next 30 plans
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | No | $0 | AL |
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T1 | No | $0 | CA |
| 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 |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | Yes | $0 | CA |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Advance (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Plus (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | Yes | $0 | CA |
| 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 |
| Florida Complete Care (HMO I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| 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 |
| SECUR Advantage (HMO I-SNP) | Secur Inc | T1 | No | $4.80 | FL |
| SECUR Enhanced (HMO I-SNP) | Secur 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 |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS Insurance Company | T1 | Yes | $5.00 | OK |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 0.6 ML pegfilgrastim-jmdb 10 MG/ML Prefilled Syringe [Fulphila] covered by Medicare Part D?
Yes, 0.6 ML pegfilgrastim-jmdb 10 MG/ML Prefilled Syringe [Fulphila] is covered by 1,885 Medicare Part D plans (37.3% of all Part D formularies).
What tier is 0.6 ML pegfilgrastim-jmdb 10 MG/ML Prefilled Syringe [Fulphila] on Medicare Part D plans?
0.6 ML pegfilgrastim-jmdb 10 MG/ML Prefilled Syringe [Fulphila] averages Tier 4.1 across Part D plans, ranging from Tier 1 to Tier 5.
Does 0.6 ML pegfilgrastim-jmdb 10 MG/ML Prefilled Syringe [Fulphila] require prior authorization?
79.9% of Part D formularies require prior authorization for 0.6 ML pegfilgrastim-jmdb 10 MG/ML Prefilled Syringe [Fulphila]. Step therapy: 0.6%. Quantity limits: 33%.
How much does Medicare spend on 0.6 ML pegfilgrastim-jmdb 10 MG/ML Prefilled Syringe [Fulphila]?
In 2023, total Medicare Part D spending on 0.6 ML pegfilgrastim-jmdb 10 MG/ML Prefilled Syringe [Fulphila] was $624,238, covering 173 beneficiaries. The average spend per beneficiary was $3,608.31.
Read our methodology - how this data is sourced, computed, and verified.
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