{14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule [Tecfidera]) } Pack [Tecfidera 30-Day Starter Pack]
dimethyl fumarate
RxCUI: 1373498
What the CMS Formulary Data Shows for {14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule [Tecfidera]) } Pack [Tecfidera 30-Day Starter Pack]
Per the CMS 2026 Part D formulary file, {14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule [Tecfidera]) } Pack [Tecfidera 30-Day Starter Pack] (RxNorm concept RXCUI 1373498, generic name dimethyl fumarate) appears on 3 distinct formulary files spanning 17 Medicare Part D plan offerings - 0.3% 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 3.7.
Real-world access to {14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule [Tecfidera]) } Pack [Tecfidera 30-Day Starter Pack] depends on utilization management as much as tier placement: 33.3% of covering formularies require prior authorization. 0% require step therapy. 100% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 3,154 Part D beneficiaries filled {14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule [Tecfidera]) } Pack [Tecfidera 30-Day Starter Pack] in 2023, with total plan-and-beneficiary spending of $234,518,996 and an average per-beneficiary annual cost of $74,356.05. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry {14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule [Tecfidera]) } Pack [Tecfidera 30-Day Starter Pack] today.
Coverage Details
- Formularies covering
- 3
- Plans covering
- 17
- Coverage rate
- 0.3%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 33.3% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 100% of formularies
2023 Medicare Spending
- Beneficiaries
- 3,154
- Total spending
- $234,518,996
- Avg per beneficiary
- $74,356.05
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering {14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule [Tecfidera]) } Pack [Tecfidera 30-Day Starter Pack]
17 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $0 | NY |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $34.50 | NY |
| Personal Choice 65 Achieve Rx (PPO) | QCC INSURANCE COMPANY | T5 | No | $0 | PA |
| Keystone 65 Focus Rx (HMO-POS) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | No | $0 | PA |
| Keystone 65 Focus Rx (HMO-POS) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | No | $0 | PA |
| Keystone 65 Basic Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | No | $0 | PA |
| AmeriHealth Medicare Core (PPO) | AMERIHEALTH INSURANCE COMPANY OF NEW JERSEY | T5 | No | $0 | NJ |
| AmeriHealth Medicare Ultimate (PPO) | AMERIHEALTH INSURANCE COMPANY OF NEW JERSEY | T5 | No | $0 | NJ |
| Keystone 65 Essential Rx (HMO-POS) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | No | $31.00 | PA |
| AmeriHealth Medicare Enhanced (PPO) | AMERIHEALTH INSURANCE COMPANY OF NEW JERSEY | T5 | No | $36.00 | NJ |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | No | $47.00 | PA |
| Keystone 65 Preferred Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | No | $59.70 | PA |
| Keystone 65 Select Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | No | $63.50 | PA |
| Keystone 65 Preferred Rx (HMO) | KEYSTONE HEALTH PLAN EAST, INC. | T5 | No | $79.70 | PA |
| Personal Choice 65 Plus Rx (PPO) | QCC INSURANCE COMPANY | T5 | No | $81.20 | PA |
| Personal Choice 65 Rx (PPO) | QCC INSURANCE COMPANY | T5 | No | $102.20 | PA |
| Personal Choice 65 Rx (PPO) | QCC INSURANCE COMPANY | T5 | No | $112.70 | PA |
Frequently Asked Questions
Is {14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule [Tecfidera]) } Pack [Tecfidera 30-Day Starter Pack] covered by Medicare Part D?
Yes, {14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule [Tecfidera]) } Pack [Tecfidera 30-Day Starter Pack] is covered by 17 Medicare Part D plans (0.3% of all Part D formularies).
What tier is {14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule [Tecfidera]) } Pack [Tecfidera 30-Day Starter Pack] on Medicare Part D plans?
{14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule [Tecfidera]) } Pack [Tecfidera 30-Day Starter Pack] averages Tier 3.7 across Part D plans, ranging from Tier 1 to Tier 5.
Does {14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule [Tecfidera]) } Pack [Tecfidera 30-Day Starter Pack] require prior authorization?
33.3% of Part D formularies require prior authorization for {14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule [Tecfidera]) } Pack [Tecfidera 30-Day Starter Pack]. Step therapy: 0%. Quantity limits: 100%.
How much does Medicare spend on {14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule [Tecfidera]) } Pack [Tecfidera 30-Day Starter Pack]?
In 2023, total Medicare Part D spending on {14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule [Tecfidera]) } Pack [Tecfidera 30-Day Starter Pack] was $234,518,996, covering 3,154 beneficiaries. The average spend per beneficiary was $74,356.05.
Read our methodology - how this data is sourced, computed, and verified.