Medicare Part D coverage · 24 · RxCUI 2196900
24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq]
Per the CMS 2026 Part D formulary file, 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq] is covered by 4,960 Medicare Part D plans (98.2% of enrollable products), averaging Tier 4.2, with prior authorization required on 98.7% of covering formularies.
- 98.2%
- Plan coverage
- 4,960
- Plans covering
- T4.2
- Avg tier
- 98.7%
- Prior auth required
What the CMS Formulary Data Shows for 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq]
Per the CMS 2026 Part D formulary file, 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq] (RxNorm concept RXCUI 2196900, generic name 24) appears on 308 distinct formulary files spanning 4,960 Medicare Part D plan offerings - 98.2% 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 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq] depends on utilization management as much as tier placement: 98.7% of covering formularies require prior authorization. 0% require step therapy. 82.1% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 21,424 Part D beneficiaries filled 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq] in 2023, with total plan-and-beneficiary spending of $976,330,771 and an average per-beneficiary annual cost of $45,571.82. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq] today.
Coverage Details
- Formularies covering
- 308
- Plans covering
- 4,960
- Coverage rate
- 98.2%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 98.7% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 82.1% of formularies
2023 Medicare Spending
- Beneficiaries
- 21,424
- Total spending
- $976,330,771
- Avg per beneficiary
- $45,571.82
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq]
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 |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $0 | GA |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq] covered by Medicare Part D?
Yes, 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq] is covered by 4,960 Medicare Part D plans (98.2% of all Part D formularies).
What tier is 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq] on Medicare Part D plans?
24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 5.
Does 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq] require prior authorization?
98.7% of Part D formularies require prior authorization for 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq]. Step therapy: 0%. Quantity limits: 82.1%.
How much does Medicare spend on 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq]?
In 2023, total Medicare Part D spending on 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq] was $976,330,771, covering 21,424 beneficiaries. The average spend per beneficiary was $45,571.82.
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
- amikacin liposomal 70.3 MG/ML Inhalation Suspension [Arikayce] T4.2
- cannabidiol 100 MG/ML Oral Solution [Epidiolex] T4.2
- fecal microbiota spores, live-brpk 30000000 UNT Oral Capsule [Vowst] T4.2
- fenfluramine 2.2 MG/ML Oral Solution [Fintepla] T4.2
- ganaxolone 50 MG/ML Oral Suspension [Ztalmy] T4.2
- ibrutinib 140 MG Oral Capsule [Imbruvica] T4.2
Similar prior-authorization rate
- 1 ML erenumab-aooe 70 MG/ML Auto-Injector [Aimovig] 98.7% PA
- 1 ML galcanezumab-gnlm 120 MG/ML Auto-Injector [Emgality] 98.7% PA
- {28 (ivacaftor 150 MG / tezacaftor 100 MG Oral Tablet) / 28 (ivacaftor 150 MG Oral Tablet) } Pack [Symdeko (100 MG / 150 MG; 150 MG)] 98.7% PA
- immunoglobulin G, human 5000 MG Injection [Gammagard] 98.7% PA
- {28 (elexacaftor 80 MG / ivacaftor 60 MG / tezacaftor 40 MG Oral Granules) / 28 (ivacaftor 59.5 MG Oral Granules) } Pack [Trikafta (80 MG / 40 MG / 60 MG; 59.5 MG) Granules] 98.7% PA
- upadacitinib 1 MG/ML Oral Solution [Rinvoq] 98.7% PA