0.8 ML eplontersen 56.3 MG/ML Auto-Injector [Wainua]
eplontersen
RxCUI: 2671950
What the CMS Formulary Data Shows for 0.8 ML eplontersen 56.3 MG/ML Auto-Injector [Wainua]
Per the CMS 2026 Part D formulary file, 0.8 ML eplontersen 56.3 MG/ML Auto-Injector [Wainua] (RxNorm concept RXCUI 2671950, generic name eplontersen) appears on 12 distinct formulary files spanning 44 Medicare Part D plan offerings - 0.9% 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 3.8.
Real-world access to 0.8 ML eplontersen 56.3 MG/ML Auto-Injector [Wainua] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 75% 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 0.8 ML eplontersen 56.3 MG/ML Auto-Injector [Wainua] today.
Coverage Details
- Formularies covering
- 12
- Plans covering
- 44
- Coverage rate
- 0.9%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 75% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 0.8 ML eplontersen 56.3 MG/ML Auto-Injector [Wainua]
44 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| NaviCare (HMO D-SNP) | FALLON COMMUNITY HEALTH PLAN | T1 | Yes | $0 | MA |
| 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 |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| HAP Medicare Explore (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T5 | Yes | $0 | MI |
| HAP Medicare Prime (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T5 | Yes | $0 | MI |
| HAP Medicare Connect (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T5 | Yes | $0 | MI |
| HAP Medicare Complete Duals (HMO D-SNP) | HEALTH ALLIANCE PLAN OF MICHIGAN | T5 | Yes | $0 | MI |
| HAP Medicare Superior (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T5 | Yes | $0 | MI |
| Henry Ford Select (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T5 | Yes | $0 | MI |
| Health New England Medicare Compass (PPO) | HEALTH NEW ENGLAND, INC. | T5 | Yes | $0 | MA |
| Health New England Medicare Value (HMO) | HEALTH NEW ENGLAND, INC. | T5 | Yes | $0 | MA |
| Fallon Medicare Plus Orange (HMO) | FALLON COMMUNITY HEALTH PLAN | T5 | Yes | $0 | MA |
| Health First Rewards H1099-014 (HMO) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $0 | FL |
| Health First SunSaver H1099-016 (HMO) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $0 | FL |
| Health First Complete Care H1099-023 (HMO) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $0 | FL |
| Health First Emerald Plus H1099-024 (HMO) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $0 | FL |
| Health First Premier Access H1099-025 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $0 | FL |
| Health First Emerald Plus H1099-026 (HMO) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $0 | FL |
| Health First Premier Access H1099-027 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $0 | FL |
| Health First Emerald Plus H1099-028 (HMO) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $0 | FL |
| Mass General Brigham Advantage (PPO) | Mass General Brigham Health Plan, Inc. | T5 | Yes | $0 | MA |
| CareOregon Advantage Plus (HMO D-SNP) | HEALTH PLAN OF CAREOREGON, INC. | T5 | Yes | $0 | OR |
| HAP Member Assist (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T5 | Yes | $8.80 | MI |
| HAP Medicare Complete Assist (PPO D-SNP) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T5 | Yes | $8.80 | MI |
| HAP Medicare Diabetes and Heart (HMO C-SNP) | HEALTH ALLIANCE PLAN OF MICHIGAN | T5 | Yes | $8.80 | MI |
| HAP Senior Plus Henry Ford Tiered Access (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T5 | Yes | $11.30 | MI |
| HAP Senior Plus (HMO-POS) | HEALTH ALLIANCE PLAN OF MICHIGAN | T5 | Yes | $13.50 | MI |
| Health First Value H1099-006 (HMO) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $15.00 | FL |
| Health New England Medicare Premium (HMO) | HEALTH NEW ENGLAND, INC. | T5 | Yes | $15.80 | MA |
| HAP Senior Plus (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T5 | Yes | $42.60 | MI |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | Yes | $47.00 | PA |
| Health First Classic H1099-001 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T5 | Yes | $49.40 | FL |
| Fallon Medicare Plus Green (HMO) | FALLON COMMUNITY HEALTH PLAN | T5 | Yes | $56.40 | MA |
| Health New England Medicare Plus (HMO) | HEALTH NEW ENGLAND, INC. | T5 | Yes | $58.40 | MA |
| Keystone 65 Preferred Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | Yes | $59.70 | PA |
| Mass General Brigham Advantage Secure (HMO-POS) | Mass General Brigham Health Plan, Inc. | T5 | Yes | $62.00 | MA |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | Yes | $63.50 | PA |
| Fallon Medicare Plus Blue (HMO) | FALLON COMMUNITY HEALTH PLAN | T5 | Yes | $72.10 | MA |
| Keystone 65 Preferred Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | Yes | $79.70 | PA |
| Mass General Brigham Advantage Premier (PPO) | Mass General Brigham Health Plan, Inc. | T5 | Yes | $79.70 | MA |
| Personal Choice 65 Rx (PPO) | QCC INSURANCE COMPANY | T5 | Yes | $102.20 | PA |
| Personal Choice 65 Rx (PPO) | QCC INSURANCE COMPANY | T5 | Yes | $112.70 | PA |
| Mass General Brigham Advantage Signature (PPO) | Mass General Brigham Health Plan, Inc. | T5 | Yes | $147.20 | MA |
Frequently Asked Questions
Is 0.8 ML eplontersen 56.3 MG/ML Auto-Injector [Wainua] covered by Medicare Part D?
Yes, 0.8 ML eplontersen 56.3 MG/ML Auto-Injector [Wainua] is covered by 44 Medicare Part D plans (0.9% of all Part D formularies).
What tier is 0.8 ML eplontersen 56.3 MG/ML Auto-Injector [Wainua] on Medicare Part D plans?
0.8 ML eplontersen 56.3 MG/ML Auto-Injector [Wainua] averages Tier 3.8 across Part D plans, ranging from Tier 1 to Tier 5.
Does 0.8 ML eplontersen 56.3 MG/ML Auto-Injector [Wainua] require prior authorization?
100% of Part D formularies require prior authorization for 0.8 ML eplontersen 56.3 MG/ML Auto-Injector [Wainua]. Step therapy: 0%. Quantity limits: 75%.
Read our methodology - how this data is sourced, computed, and verified.