Medicare Part D coverage · 1 · RxCUI 849599
1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia]
Per the CMS 2026 Part D formulary file, 1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia] is covered by 330 Medicare Part D plans (6.5% of enrollable products), averaging Tier 3.8, with prior authorization required on 100% of covering formularies.
- 6.5%
- Plan coverage
- 330
- Plans covering
- T3.8
- Avg tier
- 100%
- Prior auth required
What the CMS Formulary Data Shows for 1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia]
Per the CMS 2026 Part D formulary file, 1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia] (RxNorm concept RXCUI 849599, generic name 1) appears on 114 distinct formulary files spanning 330 Medicare Part D plan offerings - 6.5% 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 1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 54.4% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 1,028 Part D beneficiaries filled 1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia] in 2023, with total plan-and-beneficiary spending of $18,293,307 and an average per-beneficiary annual cost of $17,795.05. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia] today.
Coverage Details
- Formularies covering
- 114
- Plans covering
- 330
- Coverage rate
- 6.5%
- 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
- 54.4% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,028
- Total spending
- $18,293,307
- Avg per beneficiary
- $17,795.05
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia]
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 | Yes | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | Yes | $0 | AL |
| 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 |
| 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 |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | Yes | $4.80 | FL |
Show the next 30 plans
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | Yes | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | American Health Plan OF FL, Inc. | T1 | Yes | $4.80 | FL |
| SECUR Advantage (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| SECUR Enhanced (HMO I-SNP) | Secur Inc | T1 | Yes | $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 | Yes | $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 | Yes | $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 | Yes | $12.00 | CA |
| Liberty Medicare Dual Plan (HMO D-SNP) | Liberty Advantage, LLC | T1 | Yes | $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 | Yes | $23.20 | MD |
| American Health Advantage of Mississippi (HMO I-SNP) | American Health Plan OF MS, Inc. | T1 | Yes | $23.80 | MS |
| Senior Care (HMO I-SNP) | Lifeworks Advantage, LLC | T1 | Yes | $24.60 | VA |
| PruittHealth Premier (HMO I-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $25.40 | GA |
| Georgia Health Advantage (HMO I-SNP) | Georgia Assurance, Inc. | T1 | Yes | $25.40 | GA |
| Georgia Health Advantage Choice (HMO I-SNP) | Georgia Assurance, Inc. | T1 | Yes | $25.40 | GA |
| American Health Advantage of Tennessee (HMO I-SNP) | American Health Plan, Inc. | T1 | Yes | $27.70 | TN |
| Simpra Advantage Nursing Home Plan (PPO I-SNP) | Simpra Advantage, Inc. | T1 | Yes | $27.70 | AL |
| American Health Advantage of Oklahoma (HMO I-SNP) | Oklahoma Superior Select, Inc. | T1 | Yes | $28.20 | OK |
| NHC Advantage (HMO I-SNP) | NHC Advantage, LLC | T1 | Yes | $31.00 | MO, NC, SC, TN |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia] covered by Medicare Part D?
Yes, 1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia] is covered by 330 Medicare Part D plans (6.5% of all Part D formularies).
What tier is 1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia] on Medicare Part D plans?
1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia] averages Tier 3.8 across Part D plans, ranging from Tier 1 to Tier 5.
Does 1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia] require prior authorization?
100% of Part D formularies require prior authorization for 1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia]. Step therapy: 0%. Quantity limits: 54.4%.
How much does Medicare spend on 1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia]?
In 2023, total Medicare Part D spending on 1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia] was $18,293,307, covering 1,028 beneficiaries. The average spend per beneficiary was $17,795.05.
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
- fingolimod 0.5 MG Oral Capsule T3.8
- alanine 5.4 MG/ML / arginine 12 MG/ML / aspartate 3.2 MG/ML / cysteine 0.16 MG/ML / glutamate 5 MG/ML / glycine 3.6 MG/ML / histidine 4.8 MG/ML / isoleucine 8.2 MG/ML / leucine 14 MG/ML / lysine 8.2 MG/ML / methionine 3.4 MG/ML / phenylalanine 4.8 MG/ML / proline 6.8 MG/ML / serine 3.8 MG/ML / taurine 0.25 MG/ML / threonine 4.2 MG/ML / tryptophan 2 MG/ML / tyrosine 2.4 MG/ML / valine 7.8 MG/ML Injectable Solution [PremaSol] T3.8
- risperidone 12.5 MG Injection [Risperdal] T3.8
- ledipasvir 90 MG / sofosbuvir 400 MG Oral Tablet T3.8
- 1.7 ML denosumab-bnht 70 MG/ML Injection [Bomyntra] T3.8
- dapsone 0.05 MG/MG Topical Gel T3.8
Similar prior-authorization rate
- azathioprine 50 MG Oral Tablet 100% PA
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- 0.5 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] 100% PA
- sotagliflozin 200 MG Oral Tablet [Inpefa] 100% PA
- mycophenolate mofetil 250 MG Oral Capsule 100% PA
- mycophenolate mofetil 500 MG Oral Tablet 100% PA