1 ML epoetin alfa 4000 UNT/ML Injection [Epogen]
epoetin alfa
RxCUI: 205923
What the CMS Formulary Data Shows for 1 ML epoetin alfa 4000 UNT/ML Injection [Epogen]
Per the CMS 2026 Part D formulary file, 1 ML epoetin alfa 4000 UNT/ML Injection [Epogen] (RxNorm concept RXCUI 205923, generic name epoetin alfa) appears on 19 distinct formulary files spanning 72 Medicare Part D plan offerings - 1.4% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 3.5.
Real-world access to 1 ML epoetin alfa 4000 UNT/ML Injection [Epogen] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 5.3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 4,041 Part D beneficiaries filled 1 ML epoetin alfa 4000 UNT/ML Injection [Epogen] in 2023, with total plan-and-beneficiary spending of $7,680,197 and an average per-beneficiary annual cost of $1,900.57. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 1 ML epoetin alfa 4000 UNT/ML Injection [Epogen] today.
Coverage Details
- Formularies covering
- 19
- Plans covering
- 72
- Coverage rate
- 1.4%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 5.3% of formularies
2023 Medicare Spending
- Beneficiaries
- 4,041
- Total spending
- $7,680,197
- Avg per beneficiary
- $1,900.57
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 1 ML epoetin alfa 4000 UNT/ML Injection [Epogen]
72 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| Geisinger Gold Preferred Complete Rx (PPO) | GEISINGER INDEMNITY INSURANCE COMPANY | T3 | Yes | $0 | PA |
| Geisinger Gold Secure Rx (HMO D-SNP) | GEISINGER HEALTH PLAN | T3 | Yes | $0 | PA |
| Geisinger Gold Classic 360 Rx (HMO) | GEISINGER HEALTH PLAN | T3 | Yes | $0 | PA |
| Geisinger Gold Classic Essential Rx (HMO) | GEISINGER HEALTH PLAN | T3 | Yes | $0 | PA |
| Geisinger Gold Value Rx (HMO) | GEISINGER HEALTH PLAN | T3 | Yes | $23.00 | PA |
| Geisinger Gold Classic Complete Rx (HMO) | GEISINGER HEALTH PLAN | T3 | Yes | $48.00 | PA |
| Geisinger Gold Classic Advantage Rx (HMO) | GEISINGER HEALTH PLAN | T3 | Yes | $99.30 | PA |
| Geisinger Gold Preferred Advantage Rx (PPO) | GEISINGER INDEMNITY INSURANCE COMPANY | T3 | Yes | $112.00 | PA |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | Yes | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T4 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | Yes | $0 | UT |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | Yes | $0 | NV |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | Yes | $0 | CO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | Yes | $0 | CO |
| Select Health Medicare Flex (HMO) | SELECTHEALTH, INC. | T4 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | Yes | $0 | CO |
| Select Health Medicare Active (HMO) | SELECTHEALTH, INC. | T4 | Yes | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T4 | Yes | $0 | NV |
| Select Health Medicare Wellness (HMO) | SELECTHEALTH, INC. | T4 | Yes | $0 | NV |
| HAP Medicare Explore (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T4 | Yes | $0 | MI |
| HAP Medicare Prime (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T4 | Yes | $0 | MI |
| HAP Medicare Connect (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T4 | Yes | $0 | MI |
| HAP Medicare Complete Duals (HMO D-SNP) | HEALTH ALLIANCE PLAN OF MICHIGAN | T4 | Yes | $0 | MI |
| HAP Medicare Superior (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T4 | Yes | $0 | MI |
| Henry Ford Select (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T4 | Yes | $0 | MI |
| UPMC for Life HMO Premier Rx (HMO) | UPMC HEALTH PLAN, INC. | T4 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC FOR YOU, INC | T4 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC FOR YOU, INC | T4 | Yes | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | UPMC HEALTH NETWORK, INC. | T4 | Yes | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | UPMC HEALTH NETWORK, INC. | T4 | Yes | $0 | PA |
| UPMC for Life PPO Essential Care Rx (PPO) | UPMC HEALTH NETWORK, INC. | T4 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC HEALTH COVERAGE, INC. | T4 | Yes | $0 | PA |
| Troy Medicare (HMO) | TROY HEALTH, INC. | T4 | Yes | $0 | NC |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | TROY HEALTH, INC. | T4 | Yes | $0 | NC |
| Contra Costa Health Care Plus (HMO D-SNP) | CONTRA COSTA COUNTY MEDICAL SERVICE DBA CONTRA COSTA HEALTH | T4 | Yes | $0 | CA |
| Keystone First VIP Choice (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T4 | Yes | $0 | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T4 | Yes | $0 | PA |
| First Choice VIP Care (HMO D-SNP) | SELECT HEALTH OF SOUTH CAROLINA, INC. | T4 | Yes | $0 | SC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T4 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T4 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS FLORIDA INC | T4 | Yes | $0 | FL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS LOUISIANA, INC. | T4 | Yes | $0 | LA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS NORTH CAROLINA, INC. | T4 | Yes | $0 | NC |
Frequently Asked Questions
Is 1 ML epoetin alfa 4000 UNT/ML Injection [Epogen] covered by Medicare Part D?
Yes, 1 ML epoetin alfa 4000 UNT/ML Injection [Epogen] is covered by 72 Medicare Part D plans (1.4% of all Part D formularies).
What tier is 1 ML epoetin alfa 4000 UNT/ML Injection [Epogen] on Medicare Part D plans?
1 ML epoetin alfa 4000 UNT/ML Injection [Epogen] averages Tier 3.5 across Part D plans, ranging from Tier 1 to Tier 4.
Does 1 ML epoetin alfa 4000 UNT/ML Injection [Epogen] require prior authorization?
100% of Part D formularies require prior authorization for 1 ML epoetin alfa 4000 UNT/ML Injection [Epogen]. Step therapy: 0%. Quantity limits: 5.3%.
How much does Medicare spend on 1 ML epoetin alfa 4000 UNT/ML Injection [Epogen]?
In 2023, total Medicare Part D spending on 1 ML epoetin alfa 4000 UNT/ML Injection [Epogen] was $7,680,197, covering 4,041 beneficiaries. The average spend per beneficiary was $1,900.57.
Read our methodology - how this data is sourced, computed, and verified.