1 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq]
pegvaliase-pqpz
RxCUI: 2046380
What the CMS Formulary Data Shows for 1 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq]
Per the CMS 2026 Part D formulary file, 1 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] (RxNorm concept RXCUI 2046380, generic name pegvaliase-pqpz) appears on 22 distinct formulary files spanning 198 Medicare Part D plan offerings - 3.9% 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 4.1.
Real-world access to 1 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] depends on utilization management as much as tier placement: 95.5% of covering formularies require prior authorization. 0% require step therapy. 18.2% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 91 Part D beneficiaries filled 1 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] in 2023, with total plan-and-beneficiary spending of $20,307,239 and an average per-beneficiary annual cost of $223,156.47. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 1 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] today.
Coverage Details
- Formularies covering
- 22
- Plans covering
- 198
- Coverage rate
- 3.9%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 95.5% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 18.2% of formularies
2023 Medicare Spending
- Beneficiaries
- 91
- Total spending
- $20,307,239
- Avg per beneficiary
- $223,156.47
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 1 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq]
100 Medicare Advantage plans with Part D drug coverage include this drug.
Frequently Asked Questions
Is 1 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] covered by Medicare Part D?
Yes, 1 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] is covered by 198 Medicare Part D plans (3.9% of all Part D formularies).
What tier is 1 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] on Medicare Part D plans?
1 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] averages Tier 4.1 across Part D plans, ranging from Tier 1 to Tier 5.
Does 1 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] require prior authorization?
95.5% of Part D formularies require prior authorization for 1 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq]. Step therapy: 0%. Quantity limits: 18.2%.
How much does Medicare spend on 1 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq]?
In 2023, total Medicare Part D spending on 1 ML pegvaliase-pqpz 20 MG/ML Prefilled Syringe [Palynziq] was $20,307,239, covering 91 beneficiaries. The average spend per beneficiary was $223,156.47.
Read our methodology - how this data is sourced, computed, and verified.