Medicare Part D coverage · {3 · RxCUI 2641669

{3 (0.8 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) } Pack [Hyrimoz Pediatric Crohn's Starter Kit Patient Weight > 40 KG]

Per the CMS 2026 Part D formulary file, {3 (0.8 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) } Pack [Hyrimoz Pediatric Crohn's Starter Kit Patient Weight > 40 KG] is covered by 14 Medicare Part D plans (0.3% of enrollable products), averaging Tier 5, with prior authorization required on 100% of covering formularies.

0.3%
Plan coverage
14
Plans covering
T5
Avg tier
100%
Prior auth required

Verify with CMS →

Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.

What the CMS Formulary Data Shows for {3 (0.8 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) } Pack [Hyrimoz Pediatric Crohn's Starter Kit Patient Weight > 40 KG]

Per the CMS 2026 Part D formulary file, {3 (0.8 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) } Pack [Hyrimoz Pediatric Crohn's Starter Kit Patient Weight > 40 KG] (RxNorm concept RXCUI 2641669, generic name {3) appears on 1 distinct formulary file spanning 14 Medicare Part D plan offerings - 0.3% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 5 to Tier 5, with a cross-plan average of Tier 5.

Real-world access to {3 (0.8 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) } Pack [Hyrimoz Pediatric Crohn's Starter Kit Patient Weight > 40 KG] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 100% 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 {3 (0.8 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) } Pack [Hyrimoz Pediatric Crohn's Starter Kit Patient Weight > 40 KG] today.

Coverage Details

Formularies covering
1
Plans covering
14
Coverage rate
0.3%
Tier range
Tier 5, Specialty
Average tier
Tier 5, Specialty

Restrictions

Prior authorization required
100% of formularies
Step therapy required
0% of formularies
Quantity limits
100% of formularies

Tier Distribution Across Plans

14 plans
Tier 5, Specialty

Medicare Advantage Plans (MA-PD) Covering {3 (0.8 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) } Pack [Hyrimoz Pediatric Crohn's Starter Kit Patient Weight > 40 KG]

14 Medicare Advantage plans with Part D drug coverage include this drug.

Plan Insurer Tier PA Premium States
Gundersen Quartz Med Advantage Basic D (w/Rx) (HMO) Quartz Health Plan Corporation T5 Yes $0 IA, WI
UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) Quartz Health Plan Corporation T5 Yes $0 WI
Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) Quartz Health Plan MN Corporation T5 Yes $0 MN
Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) Quartz Health Plan MN Corporation T5 Yes $8.20 MN
Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) Quartz Health Plan Corporation T5 Yes $21.10 WI
UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) Quartz Health Plan Corporation T5 Yes $21.10 WI
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) Quartz Health Plan Corporation T5 Yes $25.70 IA, WI
UW Health Quartz Med Advantage Core D (w/Rx) (HMO) Quartz Health Plan Corporation T5 Yes $34.00 WI
Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) Quartz Health Plan MN Corporation T5 Yes $67.40 MN
Gundersen Quartz Med Advantage Value D (w/Rx) (HMO) Quartz Health Plan Corporation T5 Yes $71.40 IA, WI
UW Health Quartz Med Advantage Value D (w/Rx) (HMO) Quartz Health Plan Corporation T5 Yes $76.90 WI
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) Quartz Health Plan Corporation T5 Yes $83.30 IA, WI
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO) Quartz Health Plan Corporation T5 Yes $162.00 WI
Gundersen MN Quartz Med Advantage Elite D (w/Rx) (HMO) Quartz Health Plan MN Corporation T5 Yes $184.00 MN

Frequently Asked Questions

Is {3 (0.8 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) } Pack [Hyrimoz Pediatric Crohn's Starter Kit Patient Weight > 40 KG] covered by Medicare Part D?

Yes, {3 (0.8 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) } Pack [Hyrimoz Pediatric Crohn's Starter Kit Patient Weight > 40 KG] is covered by 14 Medicare Part D plans (0.3% of all Part D formularies).

What tier is {3 (0.8 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) } Pack [Hyrimoz Pediatric Crohn's Starter Kit Patient Weight > 40 KG] on Medicare Part D plans?

{3 (0.8 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) } Pack [Hyrimoz Pediatric Crohn's Starter Kit Patient Weight > 40 KG] averages Tier 5 across Part D plans, ranging from Tier 5 to Tier 5.

Does {3 (0.8 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) } Pack [Hyrimoz Pediatric Crohn's Starter Kit Patient Weight > 40 KG] require prior authorization?

100% of Part D formularies require prior authorization for {3 (0.8 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) } Pack [Hyrimoz Pediatric Crohn's Starter Kit Patient Weight > 40 KG]. Step therapy: 0%. Quantity limits: 100%.

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

Similar prior-authorization rate

Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare