Medicare Part D coverage · 0.6 · RxCUI 2469340
0.6 ML pegfilgrastim-apgf 10 MG/ML Prefilled Syringe [Nyvepria]
Per the CMS 2026 Part D formulary file, 0.6 ML pegfilgrastim-apgf 10 MG/ML Prefilled Syringe [Nyvepria] is covered by 1,017 Medicare Part D plans (20.1% of enrollable products), averaging Tier 3.9, with prior authorization required on 75.2% of covering formularies.
- 20.1%
- Plan coverage
- 1,017
- Plans covering
- T3.9
- Avg tier
- 75.2%
- Prior auth required
What the CMS Formulary Data Shows for 0.6 ML pegfilgrastim-apgf 10 MG/ML Prefilled Syringe [Nyvepria]
Per the CMS 2026 Part D formulary file, 0.6 ML pegfilgrastim-apgf 10 MG/ML Prefilled Syringe [Nyvepria] (RxNorm concept RXCUI 2469340, generic name 0.6) appears on 125 distinct formulary files spanning 1,017 Medicare Part D plan offerings - 20.1% 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 0.6 ML pegfilgrastim-apgf 10 MG/ML Prefilled Syringe [Nyvepria] depends on utilization management as much as tier placement: 75.2% 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 282 Part D beneficiaries filled 0.6 ML pegfilgrastim-apgf 10 MG/ML Prefilled Syringe [Nyvepria] in 2023, with total plan-and-beneficiary spending of $4,121,441 and an average per-beneficiary annual cost of $14,615.04. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 0.6 ML pegfilgrastim-apgf 10 MG/ML Prefilled Syringe [Nyvepria] today.
Coverage Details
- Formularies covering
- 125
- Plans covering
- 1,017
- Coverage rate
- 20.1%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 75.2% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 282
- Total spending
- $4,121,441
- Avg per beneficiary
- $14,615.04
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 0.6 ML pegfilgrastim-apgf 10 MG/ML Prefilled Syringe [Nyvepria]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T1 | No | $0 | CA |
| 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 |
| 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 |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $0 | AR |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | Yes | $0 | CA |
| 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 |
Show the next 30 plans
| 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 |
| 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 |
| 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 |
| Tribute Select (HMO-POS I-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $8.90 | AR |
| 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 |
| 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 |
| WellSense Added Value (HMO) | Boston Medical Center Health Plan, Inc. | T1 | Yes | $21.70 | NH |
| KeyCare Advantage (HMO I-SNP) | Isnp Ventures, LLC | T1 | No | $23.20 | MD |
| American Health Advantage of Mississippi (HMO I-SNP) | American Health Plan OF MS, Inc. | T1 | No | $23.80 | MS |
| Senior Care (HMO I-SNP) | Lifeworks Advantage, LLC | T1 | No | $24.60 | VA |
| PruittHealth Premier (HMO I-SNP) | Pruitthealth Premier, Inc. | T1 | No | $25.40 | GA |
| Georgia Health Advantage (HMO I-SNP) | Georgia Assurance, Inc. | T1 | No | $25.40 | GA |
| Georgia Health Advantage Choice (HMO I-SNP) | Georgia Assurance, Inc. | T1 | No | $25.40 | GA |
| American Health Advantage of Tennessee (HMO I-SNP) | American Health Plan, Inc. | T1 | No | $27.70 | TN |
| Simpra Advantage Nursing Home Plan (PPO I-SNP) | Simpra Advantage, Inc. | T1 | No | $27.70 | AL |
| American Health Advantage of Oklahoma (HMO I-SNP) | Oklahoma Superior Select, Inc. | T1 | No | $28.20 | OK |
| NHC Advantage (HMO I-SNP) | NHC Advantage, LLC | T1 | No | $31.00 | MO, NC, SC, TN |
| Alterwood Advantage Dual Value (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $31.20 | MD |
| Perennial Advantage Strive (HMO I-SNP) | Perennial Advantage OF Ohio, Inc. | T1 | No | $31.40 | OH |
| Valor Health Plan (HMO I-SNP) | TSG Guard, Inc. | T1 | Yes | $31.40 | OH |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 0.6 ML pegfilgrastim-apgf 10 MG/ML Prefilled Syringe [Nyvepria] covered by Medicare Part D?
Yes, 0.6 ML pegfilgrastim-apgf 10 MG/ML Prefilled Syringe [Nyvepria] is covered by 1,017 Medicare Part D plans (20.1% of all Part D formularies).
What tier is 0.6 ML pegfilgrastim-apgf 10 MG/ML Prefilled Syringe [Nyvepria] on Medicare Part D plans?
0.6 ML pegfilgrastim-apgf 10 MG/ML Prefilled Syringe [Nyvepria] averages Tier 3.9 across Part D plans, ranging from Tier 1 to Tier 5.
Does 0.6 ML pegfilgrastim-apgf 10 MG/ML Prefilled Syringe [Nyvepria] require prior authorization?
75.2% of Part D formularies require prior authorization for 0.6 ML pegfilgrastim-apgf 10 MG/ML Prefilled Syringe [Nyvepria]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on 0.6 ML pegfilgrastim-apgf 10 MG/ML Prefilled Syringe [Nyvepria]?
In 2023, total Medicare Part D spending on 0.6 ML pegfilgrastim-apgf 10 MG/ML Prefilled Syringe [Nyvepria] was $4,121,441, covering 282 beneficiaries. The average spend per beneficiary was $14,615.04.
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
- 0.5 ML peginterferon beta-1a 0.25 MG/ML Prefilled Syringe [Plegridy] T3.9
- 12 HR zileuton 600 MG Extended Release Oral Tablet T3.9
Similar prior-authorization rate
- 1 ML octreotide 0.1 MG/ML Injection 75.2% PA
- octreotide 0.2 MG/ML Injectable Solution 75.2% PA
- crisaborole 0.02 MG/MG Topical Ointment [Eucrisa] 75.3% PA
- vigabatrin 100 MG/ML Oral Solution [Vigafyde] 75.1% PA
- octreotide 1 MG/ML Injectable Solution 75.1% PA
- carbinoxamine maleate 0.8 MG/ML Oral Solution 75% PA