1 ML spesolimab-sbzo 150 MG/ML Prefilled Syringe [Spevigo]
spesolimab-sbzo
RxCUI: 2678984
What the CMS Formulary Data Shows for 1 ML spesolimab-sbzo 150 MG/ML Prefilled Syringe [Spevigo]
Per the CMS 2026 Part D formulary file, 1 ML spesolimab-sbzo 150 MG/ML Prefilled Syringe [Spevigo] (RxNorm concept RXCUI 2678984, generic name spesolimab-sbzo) appears on 28 distinct formulary files spanning 141 Medicare Part D plan offerings - 2.8% 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 4.3.
Real-world access to 1 ML spesolimab-sbzo 150 MG/ML Prefilled Syringe [Spevigo] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 85.7% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 20 Part D beneficiaries filled 1 ML spesolimab-sbzo 150 MG/ML Prefilled Syringe [Spevigo] in 2023, with total plan-and-beneficiary spending of $1,705,416 and an average per-beneficiary annual cost of $85,270.80. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 1 ML spesolimab-sbzo 150 MG/ML Prefilled Syringe [Spevigo] today.
Coverage Details
- Formularies covering
- 28
- Plans covering
- 141
- Coverage rate
- 2.8%
- 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
- 85.7% of formularies
2023 Medicare Spending
- Beneficiaries
- 20
- Total spending
- $1,705,416
- Avg per beneficiary
- $85,270.80
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 1 ML spesolimab-sbzo 150 MG/ML Prefilled Syringe [Spevigo]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 Maryland Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | Yes | $0 | MD |
| Provider Partners Missouri Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | Yes | $0 | MO |
| 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 |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | Yes | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | Yes | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK HEALTH OPTIONS WEST VIRGINIA INC. | T1 | Yes | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | Yes | $0 | DE |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC. | T1 | Yes | $4.80 | TX |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | Yes | $13.10 | PA |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS | T1 | Yes | $15.20 | IL |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | Yes | $17.60 | PA |
| Provider Partners Maryland Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | Yes | $31.20 | MD |
| Provider Partners Maryland Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | Yes | $31.20 | MD |
| Highmark Health Options Duals Select (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | Yes | $31.20 | DE |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | Yes | $32.70 | PA |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | Yes | $32.70 | PA |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | Yes | $36.20 | NC |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | Yes | $36.20 | NC |
| Provider Partners Indiana Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | Yes | $38.40 | IN |
| Provider Partners Indiana Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | Yes | $38.40 | IN |
| Provider Partners Kentucky Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF KENTUCKY | T1 | Yes | $38.40 | KY |
| Provider Partners Missouri Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | Yes | $43.00 | MO |
| Provider Partners Missouri Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | Yes | $43.00 | MO |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| eternalHealth Forever (HMO) | ETERNALHEALTH, INC. | T5 | Yes | $0 | MA |
| eternalHealth Freedom (PPO) | ETERNALHEALTH, INC. | T5 | Yes | $0 | MA |
| eternalHealth Give Back (PPO) | ETERNALHEALTH, INC. | T5 | Yes | $0 | MA |
| eternalHealth Horizon (HMO) | ETERNALHEALTH OF ARIZONA INC | T5 | Yes | $0 | AZ |
| eternalHealth Grand Give Back (HMO) | ETERNALHEALTH OF ARIZONA INC | T5 | Yes | $0 | AZ |
| eternalHealth + Fry's Medicare Advantage (HMO) | ETERNALHEALTH OF ARIZONA INC | T5 | Yes | $0 | AZ |
| Senior Care Plus Essential plan (HMO) | HOMETOWN HEALTH PLAN, INC. | T5 | Yes | $0 | NV |
| Senior Care Plus Complete Plan (HMO) | HOMETOWN HEALTH PLAN, INC. | T5 | Yes | $0 | NV |
| Renown Preferred Plan by Senior Care Plus (HMO) | HOMETOWN HEALTH PLAN, INC. | T5 | Yes | $0 | NV |
| Senior Care Plus Extensive Duals Plan (HMO D-SNP) | HOMETOWN HEALTH PLAN, INC. | T5 | Yes | $0 | NV |
| Senior Care Plus Enriched Duals Plan (HMO D-SNP) | HOMETOWN HEALTH PLAN, INC. | T5 | Yes | $0 | NV |
| MyAdvocate Medicare Advantage SILVER (HMO-POS) | BESHP, INC. | T5 | Yes | $0 | NE |
| Great Plain Medicare Advantage Gold (HMO I-SNP) | SANFORD HEALTH PLAN | T5 | Yes | $0 | IA, SD |
| Align ChoicePlus (PPO) | SANFORD HEALTH PLAN OF MINNESOTA | T5 | Yes | $0 | MN |
| Great Plains Medicare Advantage Gold (HMO I-SNP) | GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC. | T5 | Yes | $0 | NE |
| Align ChoicePlus (PPO) | SANFORD HEALTH PLAN | T5 | Yes | $0 | IA, SD |
| Align ChoicePlus (PPO) | SANFORD HEALTH PLAN | T5 | Yes | $0 | ND |
| Great Plains Medicare Advantage Gold (HMO I-SNP) | SANFORD HEALTH PLAN | T5 | Yes | $0 | ND |
| Align Dual Partnership (HMO D-SNP) | SANFORD HEALTH PLAN | T5 | Yes | $0 | ND |
| Ally Rx (HMO D-SNP) | SECURITY HEALTH PLAN OF WISCONSIN, INC. | T5 | Yes | $0 | WI |
| Esteem Rx (HMO-POS) | SECURITY HEALTH PLAN OF WISCONSIN, INC. | T5 | Yes | $0 | WI |
| BlueCross Total Value (PPO) | BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA | T5 | Yes | $0 | SC |
Frequently Asked Questions
Is 1 ML spesolimab-sbzo 150 MG/ML Prefilled Syringe [Spevigo] covered by Medicare Part D?
Yes, 1 ML spesolimab-sbzo 150 MG/ML Prefilled Syringe [Spevigo] is covered by 141 Medicare Part D plans (2.8% of all Part D formularies).
What tier is 1 ML spesolimab-sbzo 150 MG/ML Prefilled Syringe [Spevigo] on Medicare Part D plans?
1 ML spesolimab-sbzo 150 MG/ML Prefilled Syringe [Spevigo] averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 5.
Does 1 ML spesolimab-sbzo 150 MG/ML Prefilled Syringe [Spevigo] require prior authorization?
100% of Part D formularies require prior authorization for 1 ML spesolimab-sbzo 150 MG/ML Prefilled Syringe [Spevigo]. Step therapy: 0%. Quantity limits: 85.7%.
How much does Medicare spend on 1 ML spesolimab-sbzo 150 MG/ML Prefilled Syringe [Spevigo]?
In 2023, total Medicare Part D spending on 1 ML spesolimab-sbzo 150 MG/ML Prefilled Syringe [Spevigo] was $1,705,416, covering 20 beneficiaries. The average spend per beneficiary was $85,270.80.
Read our methodology - how this data is sourced, computed, and verified.