1 ML tildrakizumab-asmn 100 MG/ML Prefilled Syringe [Ilumya]
tildrakizumab-asmn
RxCUI: 2053458
What the CMS Formulary Data Shows for 1 ML tildrakizumab-asmn 100 MG/ML Prefilled Syringe [Ilumya]
Per the CMS 2026 Part D formulary file, 1 ML tildrakizumab-asmn 100 MG/ML Prefilled Syringe [Ilumya] (RxNorm concept RXCUI 2053458, generic name tildrakizumab-asmn) appears on 14 distinct formulary files spanning 31 Medicare Part D plan offerings - 0.6% 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 4.2.
Real-world access to 1 ML tildrakizumab-asmn 100 MG/ML Prefilled Syringe [Ilumya] depends on utilization management as much as tier placement: 100% 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 629 Part D beneficiaries filled 1 ML tildrakizumab-asmn 100 MG/ML Prefilled Syringe [Ilumya] in 2023, with total plan-and-beneficiary spending of $31,759,015 and an average per-beneficiary annual cost of $50,491.28. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 1 ML tildrakizumab-asmn 100 MG/ML Prefilled Syringe [Ilumya] today.
Coverage Details
- Formularies covering
- 14
- Plans covering
- 31
- Coverage rate
- 0.6%
- 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
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 629
- Total spending
- $31,759,015
- Avg per beneficiary
- $50,491.28
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 1 ML tildrakizumab-asmn 100 MG/ML Prefilled Syringe [Ilumya]
31 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 |
| Personal Choice 65 Achieve Rx (PPO) | QCC INSURANCE COMPANY | T5 | Yes | $0 | PA |
| Keystone 65 Focus Rx (HMO-POS) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | Yes | $0 | PA |
| Keystone 65 Focus Rx (HMO-POS) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | Yes | $0 | PA |
| Keystone 65 Basic Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | Yes | $0 | PA |
| AmeriHealth Medicare Core (PPO) | AMERIHEALTH INSURANCE COMPANY OF NEW JERSEY | T5 | Yes | $0 | NJ |
| AmeriHealth Medicare Ultimate (PPO) | AMERIHEALTH INSURANCE COMPANY OF NEW JERSEY | T5 | Yes | $0 | NJ |
| Troy Medicare (HMO) | TROY HEALTH, INC. | T5 | Yes | $0 | NC |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | TROY HEALTH, INC. | T5 | Yes | $0 | NC |
| Contra Costa Health Care Plus (HMO D-SNP) | CONTRA COSTA COUNTY MEDICAL SERVICE DBA CONTRA COSTA HEALTH | T5 | Yes | $0 | CA |
| Keystone First VIP Choice (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T5 | Yes | $0 | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T5 | Yes | $0 | PA |
| First Choice VIP Care (HMO D-SNP) | SELECT HEALTH OF SOUTH CAROLINA, INC. | T5 | Yes | $0 | SC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T5 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T5 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS FLORIDA INC | T5 | Yes | $0 | FL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS LOUISIANA, INC. | T5 | Yes | $0 | LA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH MICHIGAN, INC. | T5 | Yes | $0 | MI |
| Keystone 65 Essential Rx (HMO-POS) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | Yes | $31.00 | PA |
| AmeriHealth Medicare Enhanced (PPO) | AMERIHEALTH INSURANCE COMPANY OF NEW JERSEY | T5 | Yes | $36.00 | NJ |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | Yes | $47.00 | PA |
| Keystone 65 Preferred Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | Yes | $59.70 | PA |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | Yes | $63.50 | PA |
| Keystone 65 Preferred Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | Yes | $79.70 | PA |
| Personal Choice 65 Plus Rx (PPO) | QCC INSURANCE COMPANY | T5 | Yes | $81.20 | PA |
| 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 |
Frequently Asked Questions
Is 1 ML tildrakizumab-asmn 100 MG/ML Prefilled Syringe [Ilumya] covered by Medicare Part D?
Yes, 1 ML tildrakizumab-asmn 100 MG/ML Prefilled Syringe [Ilumya] is covered by 31 Medicare Part D plans (0.6% of all Part D formularies).
What tier is 1 ML tildrakizumab-asmn 100 MG/ML Prefilled Syringe [Ilumya] on Medicare Part D plans?
1 ML tildrakizumab-asmn 100 MG/ML Prefilled Syringe [Ilumya] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 5.
Does 1 ML tildrakizumab-asmn 100 MG/ML Prefilled Syringe [Ilumya] require prior authorization?
100% of Part D formularies require prior authorization for 1 ML tildrakizumab-asmn 100 MG/ML Prefilled Syringe [Ilumya]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on 1 ML tildrakizumab-asmn 100 MG/ML Prefilled Syringe [Ilumya]?
In 2023, total Medicare Part D spending on 1 ML tildrakizumab-asmn 100 MG/ML Prefilled Syringe [Ilumya] was $31,759,015, covering 629 beneficiaries. The average spend per beneficiary was $50,491.28.
Read our methodology - how this data is sourced, computed, and verified.