Medicare Part D coverage · 1 · RxCUI 213475
1 ML epoetin alfa 40000 UNT/ML Injection [Procrit]
Per the CMS 2026 Part D formulary file, 1 ML epoetin alfa 40000 UNT/ML Injection [Procrit] is covered by 3,422 Medicare Part D plans (67.7% of enrollable products), averaging Tier 4.3, with prior authorization required on 98% of covering formularies.
- 67.7%
- Plan coverage
- 3,422
- Plans covering
- T4.3
- Avg tier
- 98%
- Prior auth required
What the CMS Formulary Data Shows for 1 ML epoetin alfa 40000 UNT/ML Injection [Procrit]
Per the CMS 2026 Part D formulary file, 1 ML epoetin alfa 40000 UNT/ML Injection [Procrit] (RxNorm concept RXCUI 213475, generic name 1) appears on 199 distinct formulary files spanning 3,422 Medicare Part D plan offerings - 67.7% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.3.
Real-world access to 1 ML epoetin alfa 40000 UNT/ML Injection [Procrit] depends on utilization management as much as tier placement: 98% of covering formularies require prior authorization. 0% require step therapy. 1.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 24,380 Part D beneficiaries filled 1 ML epoetin alfa 40000 UNT/ML Injection [Procrit] in 2023, with total plan-and-beneficiary spending of $163,098,995 and an average per-beneficiary annual cost of $6,689.87. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 1 ML epoetin alfa 40000 UNT/ML Injection [Procrit] today.
Coverage Details
- Formularies covering
- 199
- Plans covering
- 3,422
- Coverage rate
- 67.7%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 98% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 1.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 24,380
- Total spending
- $163,098,995
- Avg per beneficiary
- $6,689.87
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 1 ML epoetin alfa 40000 UNT/ML Injection [Procrit]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| 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 |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | Yes | $0 | NY |
| 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 |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
Show the next 30 plans
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | Yes | $0 | MI |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | Yes | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | Yes | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| 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 |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | Yes | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | Yes | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $0 | MO |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Advance (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Plus (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| 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 |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Florida Complete Care (HMO I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| American Health Advantage of Florida (HMO I-SNP) | American Health Plan OF FL, Inc. | T1 | Yes | $4.80 | FL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 1 ML epoetin alfa 40000 UNT/ML Injection [Procrit] covered by Medicare Part D?
Yes, 1 ML epoetin alfa 40000 UNT/ML Injection [Procrit] is covered by 3,422 Medicare Part D plans (67.7% of all Part D formularies).
What tier is 1 ML epoetin alfa 40000 UNT/ML Injection [Procrit] on Medicare Part D plans?
1 ML epoetin alfa 40000 UNT/ML Injection [Procrit] averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 5.
Does 1 ML epoetin alfa 40000 UNT/ML Injection [Procrit] require prior authorization?
98% of Part D formularies require prior authorization for 1 ML epoetin alfa 40000 UNT/ML Injection [Procrit]. Step therapy: 0%. Quantity limits: 1.5%.
How much does Medicare spend on 1 ML epoetin alfa 40000 UNT/ML Injection [Procrit]?
In 2023, total Medicare Part D spending on 1 ML epoetin alfa 40000 UNT/ML Injection [Procrit] was $163,098,995, covering 24,380 beneficiaries. The average spend per beneficiary was $6,689.87.
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
- epoetin alfa 20000 UNT/ML Injectable Solution [Procrit] T4.3
- 28 ACTUAT teriparatide 0.02 MG/ACTUAT Pen Injector [Bonsity] T4.3
- perampanel 4 MG Oral Tablet [FYCOMPA] T4.3
- caplacizumab-yhdp 11 MG Injection [Cablivi] T4.3
- caffeine 100 MG / ergotamine tartrate 2 MG Rectal Suppository [Migergot] T4.3
- {28 (alpelisib 200 MG Oral Tablet [Vijoice]) / 28 (alpelisib 50 MG Oral Tablet [Vijoice]) } Pack [Vijoice 250 MG 28 Day] T4.3
Similar prior-authorization rate
- ubrogepant 100 MG Oral Tablet [Ubrelvy] 98% PA
- ubrogepant 50 MG Oral Tablet [Ubrelvy] 98% PA
- omaveloxolone 50 MG Oral Capsule [Skyclarys] 98% PA
- 10 ML immunoglobulin G, human 100 MG/ML Injection [Gammaked] 98% PA
- 0.5 ML ustekinumab-kfce 90 MG/ML Injection [Yesintek] 97.9% PA
- 0.5 ML ustekinumab-kfce 90 MG/ML Prefilled Syringe [Yesintek] 97.9% PA