Medicare Part D coverage · 1 · RxCUI 1928689
1 ML guselkumab 100 MG/ML Prefilled Syringe [Tremfya]
Per the CMS 2026 Part D formulary file, 1 ML guselkumab 100 MG/ML Prefilled Syringe [Tremfya] is covered by 4,612 Medicare Part D plans (91.3% of enrollable products), averaging Tier 4.2, with prior authorization required on 99.3% of covering formularies.
- 91.3%
- Plan coverage
- 4,612
- Plans covering
- T4.2
- Avg tier
- 99.3%
- Prior auth required
What the CMS Formulary Data Shows for 1 ML guselkumab 100 MG/ML Prefilled Syringe [Tremfya]
Per the CMS 2026 Part D formulary file, 1 ML guselkumab 100 MG/ML Prefilled Syringe [Tremfya] (RxNorm concept RXCUI 1928689, generic name 1) appears on 270 distinct formulary files spanning 4,612 Medicare Part D plan offerings - 91.3% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.2.
Real-world access to 1 ML guselkumab 100 MG/ML Prefilled Syringe [Tremfya] depends on utilization management as much as tier placement: 99.3% of covering formularies require prior authorization. 0.4% require step therapy. 77.4% apply quantity limits.
Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 1 ML guselkumab 100 MG/ML Prefilled Syringe [Tremfya] today.
Coverage Details
- Formularies covering
- 270
- Plans covering
- 4,612
- Coverage rate
- 91.3%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 99.3% of formularies
- Step therapy required
- 0.4% of formularies
- Quantity limits
- 77.4% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 1 ML guselkumab 100 MG/ML Prefilled Syringe [Tremfya]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | Yes | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $0 | GA |
Show the next 30 plans
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | Yes | $0 | AL |
| 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 |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| 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 |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | Yes | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | Yes | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $0 | NY |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $0 | AR |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| 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 |
| 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 |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 1 ML guselkumab 100 MG/ML Prefilled Syringe [Tremfya] covered by Medicare Part D?
Yes, 1 ML guselkumab 100 MG/ML Prefilled Syringe [Tremfya] is covered by 4,612 Medicare Part D plans (91.3% of all Part D formularies).
What tier is 1 ML guselkumab 100 MG/ML Prefilled Syringe [Tremfya] on Medicare Part D plans?
1 ML guselkumab 100 MG/ML Prefilled Syringe [Tremfya] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 5.
Does 1 ML guselkumab 100 MG/ML Prefilled Syringe [Tremfya] require prior authorization?
99.3% of Part D formularies require prior authorization for 1 ML guselkumab 100 MG/ML Prefilled Syringe [Tremfya]. Step therapy: 0.4%. Quantity limits: 77.4%.
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
- {32 (24 HR gepirone 18.2 MG Extended Release Oral Tablet [Exxua]) } Pack [Exxua Titration Pack] T4.2
- chlorambucil 2 MG Oral Tablet [Leukeran] T4.2
- 1.6 ML aripiprazole lauroxil 276 MG/ML Prefilled Syringe [Aristada] T4.2
- 2.4 ML aripiprazole lauroxil 276 MG/ML Prefilled Syringe [Aristada] T4.2
- 3.2 ML aripiprazole lauroxil 276 MG/ML Prefilled Syringe [Aristada] T4.2
- 3.9 ML aripiprazole lauroxil 273 MG/ML Prefilled Syringe [Aristada] T4.2
Similar prior-authorization rate
- levalbuterol 0.21 MG/ML Inhalation Solution 99.3% PA
- sofosbuvir 400 MG / velpatasvir 100 MG Oral Tablet 99.3% PA
- nilotinib 71 MG Oral Tablet [Danziten] 99.3% PA
- {28 (letrozole 2.5 MG Oral Tablet [Femara]) / 42 (ribociclib 200 MG Oral Tablet [Kisqali]) } Pack [Kisqali Femara Co-Pack 400] 99.3% PA
- C1 esterase inhibitor (human) 2000 UNT Injection [Haegarda] 99.3% PA
- bosentan 125 MG Oral Tablet 99.3% PA