1 ML golimumab 100 MG/ML Auto-Injector [Simponi]
golimumab
RxCUI: 1653166
What the CMS Formulary Data Shows for 1 ML golimumab 100 MG/ML Auto-Injector [Simponi]
Per the CMS 2026 Part D formulary file, 1 ML golimumab 100 MG/ML Auto-Injector [Simponi] (RxNorm concept RXCUI 1653166, generic name golimumab) appears on 17 distinct formulary files spanning 41 Medicare Part D plan offerings - 0.8% 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 golimumab 100 MG/ML Auto-Injector [Simponi] depends on utilization management as much as tier placement: 94.1% of covering formularies require prior authorization. 0% require step therapy. 58.8% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 3,463 Part D beneficiaries filled 1 ML golimumab 100 MG/ML Auto-Injector [Simponi] in 2023, with total plan-and-beneficiary spending of $177,180,473 and an average per-beneficiary annual cost of $51,163.87. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 1 ML golimumab 100 MG/ML Auto-Injector [Simponi] today.
Coverage Details
- Formularies covering
- 17
- Plans covering
- 41
- Coverage rate
- 0.8%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 94.1% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 58.8% of formularies
2023 Medicare Spending
- Beneficiaries
- 3,463
- Total spending
- $177,180,473
- Avg per beneficiary
- $51,163.87
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 1 ML golimumab 100 MG/ML Auto-Injector [Simponi]
41 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 |
| Community Care's Partnership Program (HMO D-SNP) | COMMUNITY CARE HEALTH PLAN, INC. | T1 | No | $0 | WI |
| 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 |
| Geisinger Gold Preferred Complete Rx (PPO) | GEISINGER INDEMNITY INSURANCE COMPANY | T5 | Yes | $0 | PA |
| Geisinger Gold Secure Rx (HMO D-SNP) | GEISINGER HEALTH PLAN | T5 | Yes | $0 | PA |
| Geisinger Gold Classic 360 Rx (HMO) | GEISINGER HEALTH PLAN | T5 | Yes | $0 | PA |
| Geisinger Gold Classic Essential Rx (HMO) | GEISINGER HEALTH PLAN | T5 | Yes | $0 | PA |
| 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 |
| CareOregon Advantage Plus (HMO D-SNP) | HEALTH PLAN OF CAREOREGON, INC. | T5 | Yes | $0 | OR |
| Geisinger Gold Value Rx (HMO) | GEISINGER HEALTH PLAN | T5 | Yes | $23.00 | PA |
| 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 |
| Geisinger Gold Classic Complete Rx (HMO) | GEISINGER HEALTH PLAN | T5 | Yes | $48.00 | 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 |
| Geisinger Gold Classic Advantage Rx (HMO) | GEISINGER HEALTH PLAN | T5 | Yes | $99.30 | PA |
| Personal Choice 65 Rx (PPO) | QCC INSURANCE COMPANY | T5 | Yes | $102.20 | PA |
| Geisinger Gold Preferred Advantage Rx (PPO) | GEISINGER INDEMNITY INSURANCE COMPANY | T5 | Yes | $112.00 | PA |
| Personal Choice 65 Rx (PPO) | QCC INSURANCE COMPANY | T5 | Yes | $112.70 | PA |
Frequently Asked Questions
Is 1 ML golimumab 100 MG/ML Auto-Injector [Simponi] covered by Medicare Part D?
Yes, 1 ML golimumab 100 MG/ML Auto-Injector [Simponi] is covered by 41 Medicare Part D plans (0.8% of all Part D formularies).
What tier is 1 ML golimumab 100 MG/ML Auto-Injector [Simponi] on Medicare Part D plans?
1 ML golimumab 100 MG/ML Auto-Injector [Simponi] averages Tier 4.1 across Part D plans, ranging from Tier 1 to Tier 5.
Does 1 ML golimumab 100 MG/ML Auto-Injector [Simponi] require prior authorization?
94.1% of Part D formularies require prior authorization for 1 ML golimumab 100 MG/ML Auto-Injector [Simponi]. Step therapy: 0%. Quantity limits: 58.8%.
How much does Medicare spend on 1 ML golimumab 100 MG/ML Auto-Injector [Simponi]?
In 2023, total Medicare Part D spending on 1 ML golimumab 100 MG/ML Auto-Injector [Simponi] was $177,180,473, covering 3,463 beneficiaries. The average spend per beneficiary was $51,163.87.
Read our methodology - how this data is sourced, computed, and verified.