Medicare Part D coverage · {3 · RxCUI 2532351

{3 (ponesimod 10 MG Oral Tablet [Ponvory]) / 2 (ponesimod 2 MG Oral Tablet [Ponvory]) / 2 (ponesimod 3 MG Oral Tablet [Ponvory]) / 2 (ponesimod 4 MG Oral Tablet [Ponvory]) / 1 (ponesimod 5 MG Oral Tablet [Ponvory]) / 1 (ponesimod 6 MG Oral Tablet [Ponvory]) / 1 (ponesimod 7 MG Oral Tablet [Ponvory]) / 1 (ponesimod 8 MG Oral Tablet [Ponvory]) / 1 (ponesimod 9 MG Oral Tablet [Ponvory]) } Pack [Ponvory 14 Day]

Per the CMS 2026 Part D formulary file, {3 (ponesimod 10 MG Oral Tablet [Ponvory]) / 2 (ponesimod 2 MG Oral Tablet [Ponvory]) / 2 (ponesimod 3 MG Oral Tablet [Ponvory]) / 2 (ponesimod 4 MG Oral Tablet [Ponvory]) / 1 (ponesimod 5 MG Oral Tablet [Ponvory]) / 1 (ponesimod 6 MG Oral Tablet [Ponvory]) / 1 (ponesimod 7 MG Oral Tablet [Ponvory]) / 1 (ponesimod 8 MG Oral Tablet [Ponvory]) / 1 (ponesimod 9 MG Oral Tablet [Ponvory]) } Pack [Ponvory 14 Day] is covered by 16 Medicare Part D plans (0.3% of enrollable products), averaging Tier 4.1, with prior authorization required on 100% of covering formularies.

0.3%
Plan coverage
16
Plans covering
T4.1
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 (ponesimod 10 MG Oral Tablet [Ponvory]) / 2 (ponesimod 2 MG Oral Tablet [Ponvory]) / 2 (ponesimod 3 MG Oral Tablet [Ponvory]) / 2 (ponesimod 4 MG Oral Tablet [Ponvory]) / 1 (ponesimod 5 MG Oral Tablet [Ponvory]) / 1 (ponesimod 6 MG Oral Tablet [Ponvory]) / 1 (ponesimod 7 MG Oral Tablet [Ponvory]) / 1 (ponesimod 8 MG Oral Tablet [Ponvory]) / 1 (ponesimod 9 MG Oral Tablet [Ponvory]) } Pack [Ponvory 14 Day]

Per the CMS 2026 Part D formulary file, {3 (ponesimod 10 MG Oral Tablet [Ponvory]) / 2 (ponesimod 2 MG Oral Tablet [Ponvory]) / 2 (ponesimod 3 MG Oral Tablet [Ponvory]) / 2 (ponesimod 4 MG Oral Tablet [Ponvory]) / 1 (ponesimod 5 MG Oral Tablet [Ponvory]) / 1 (ponesimod 6 MG Oral Tablet [Ponvory]) / 1 (ponesimod 7 MG Oral Tablet [Ponvory]) / 1 (ponesimod 8 MG Oral Tablet [Ponvory]) / 1 (ponesimod 9 MG Oral Tablet [Ponvory]) } Pack [Ponvory 14 Day] (RxNorm concept RXCUI 2532351, generic name {3) appears on 12 distinct formulary files spanning 16 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 4.1.

Real-world access to {3 (ponesimod 10 MG Oral Tablet [Ponvory]) / 2 (ponesimod 2 MG Oral Tablet [Ponvory]) / 2 (ponesimod 3 MG Oral Tablet [Ponvory]) / 2 (ponesimod 4 MG Oral Tablet [Ponvory]) / 1 (ponesimod 5 MG Oral Tablet [Ponvory]) / 1 (ponesimod 6 MG Oral Tablet [Ponvory]) / 1 (ponesimod 7 MG Oral Tablet [Ponvory]) / 1 (ponesimod 8 MG Oral Tablet [Ponvory]) / 1 (ponesimod 9 MG Oral Tablet [Ponvory]) } Pack [Ponvory 14 Day] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 58.3% apply quantity limits.

Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 99 Part D beneficiaries filled {3 (ponesimod 10 MG Oral Tablet [Ponvory]) / 2 (ponesimod 2 MG Oral Tablet [Ponvory]) / 2 (ponesimod 3 MG Oral Tablet [Ponvory]) / 2 (ponesimod 4 MG Oral Tablet [Ponvory]) / 1 (ponesimod 5 MG Oral Tablet [Ponvory]) / 1 (ponesimod 6 MG Oral Tablet [Ponvory]) / 1 (ponesimod 7 MG Oral Tablet [Ponvory]) / 1 (ponesimod 8 MG Oral Tablet [Ponvory]) / 1 (ponesimod 9 MG Oral Tablet [Ponvory]) } Pack [Ponvory 14 Day] in 2023, with total plan-and-beneficiary spending of $8,307,094 and an average per-beneficiary annual cost of $83,910.04. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry {3 (ponesimod 10 MG Oral Tablet [Ponvory]) / 2 (ponesimod 2 MG Oral Tablet [Ponvory]) / 2 (ponesimod 3 MG Oral Tablet [Ponvory]) / 2 (ponesimod 4 MG Oral Tablet [Ponvory]) / 1 (ponesimod 5 MG Oral Tablet [Ponvory]) / 1 (ponesimod 6 MG Oral Tablet [Ponvory]) / 1 (ponesimod 7 MG Oral Tablet [Ponvory]) / 1 (ponesimod 8 MG Oral Tablet [Ponvory]) / 1 (ponesimod 9 MG Oral Tablet [Ponvory]) } Pack [Ponvory 14 Day] today.

Coverage Details

Formularies covering
12
Plans covering
16
Coverage rate
0.3%
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
58.3% of formularies

2023 Medicare Spending

Beneficiaries
99
Total spending
$8,307,094
Avg per beneficiary
$83,910.04

Tier Distribution Across Plans

3 plans
Tier 1, Preferred Generic
1 plans
Tier 2, Generic
12 plans
Tier 5, Specialty

Medicare Advantage Plans (MA-PD) Covering {3 (ponesimod 10 MG Oral Tablet [Ponvory]) / 2 (ponesimod 2 MG Oral Tablet [Ponvory]) / 2 (ponesimod 3 MG Oral Tablet [Ponvory]) / 2 (ponesimod 4 MG Oral Tablet [Ponvory]) / 1 (ponesimod 5 MG Oral Tablet [Ponvory]) / 1 (ponesimod 6 MG Oral Tablet [Ponvory]) / 1 (ponesimod 7 MG Oral Tablet [Ponvory]) / 1 (ponesimod 8 MG Oral Tablet [Ponvory]) / 1 (ponesimod 9 MG Oral Tablet [Ponvory]) } Pack [Ponvory 14 Day]

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

Plan Insurer Tier PA Premium States
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
CalOptima Health OneCare Complete (HMO D-SNP) Orange County Health Authority T2 Yes $0 CA
Troy Medicare (HMO) Troy Health, Inc. T5 Yes $0 NC
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Troy Health, Inc. T5 Yes $0 NC
Contra Costa Health Care Plus (HMO D-SNP) Contra Costa County Medical Service DBA Contra Costa Health T5 Yes $0 CA
Keystone First VIP Choice (HMO D-SNP) Vista Health Plan, Inc. T5 Yes $0 PA
AmeriHealth Caritas VIP Care (HMO D-SNP) Vista Health Plan, Inc. T5 Yes $0 PA
First Choice VIP Care (HMO D-SNP) Select Health OF South Carolina, Inc. T5 Yes $0 SC
AmeriHealth Caritas VIP Care (HMO D-SNP) AmeriHealth Caritas VIP Next, Inc. T5 Yes $0 DE
AmeriHealth Caritas VIP Care Choice (HMO D-SNP) AmeriHealth Caritas VIP Next, Inc. T5 Yes $0 DE
AmeriHealth Caritas VIP Care (HMO D-SNP) Amerihealth Caritas Florida, Inc. T5 Yes $0 FL
AmeriHealth Caritas VIP Care (HMO D-SNP) Amerihealth Caritas Louisiana, Inc. T5 Yes $0 LA
AmeriHealth Caritas VIP Care (HMO D-SNP) Amerihealth Caritas North Carolina, Inc. T5 Yes $0 NC
AmeriHealth Caritas VIP Care (HMO D-SNP) Amerihealth Michigan, Inc. T5 Yes $0 MI

Frequently Asked Questions

Is {3 (ponesimod 10 MG Oral Tablet [Ponvory]) / 2 (ponesimod 2 MG Oral Tablet [Ponvory]) / 2 (ponesimod 3 MG Oral Tablet [Ponvory]) / 2 (ponesimod 4 MG Oral Tablet [Ponvory]) / 1 (ponesimod 5 MG Oral Tablet [Ponvory]) / 1 (ponesimod 6 MG Oral Tablet [Ponvory]) / 1 (ponesimod 7 MG Oral Tablet [Ponvory]) / 1 (ponesimod 8 MG Oral Tablet [Ponvory]) / 1 (ponesimod 9 MG Oral Tablet [Ponvory]) } Pack [Ponvory 14 Day] covered by Medicare Part D?

Yes, {3 (ponesimod 10 MG Oral Tablet [Ponvory]) / 2 (ponesimod 2 MG Oral Tablet [Ponvory]) / 2 (ponesimod 3 MG Oral Tablet [Ponvory]) / 2 (ponesimod 4 MG Oral Tablet [Ponvory]) / 1 (ponesimod 5 MG Oral Tablet [Ponvory]) / 1 (ponesimod 6 MG Oral Tablet [Ponvory]) / 1 (ponesimod 7 MG Oral Tablet [Ponvory]) / 1 (ponesimod 8 MG Oral Tablet [Ponvory]) / 1 (ponesimod 9 MG Oral Tablet [Ponvory]) } Pack [Ponvory 14 Day] is covered by 16 Medicare Part D plans (0.3% of all Part D formularies).

What tier is {3 (ponesimod 10 MG Oral Tablet [Ponvory]) / 2 (ponesimod 2 MG Oral Tablet [Ponvory]) / 2 (ponesimod 3 MG Oral Tablet [Ponvory]) / 2 (ponesimod 4 MG Oral Tablet [Ponvory]) / 1 (ponesimod 5 MG Oral Tablet [Ponvory]) / 1 (ponesimod 6 MG Oral Tablet [Ponvory]) / 1 (ponesimod 7 MG Oral Tablet [Ponvory]) / 1 (ponesimod 8 MG Oral Tablet [Ponvory]) / 1 (ponesimod 9 MG Oral Tablet [Ponvory]) } Pack [Ponvory 14 Day] on Medicare Part D plans?

{3 (ponesimod 10 MG Oral Tablet [Ponvory]) / 2 (ponesimod 2 MG Oral Tablet [Ponvory]) / 2 (ponesimod 3 MG Oral Tablet [Ponvory]) / 2 (ponesimod 4 MG Oral Tablet [Ponvory]) / 1 (ponesimod 5 MG Oral Tablet [Ponvory]) / 1 (ponesimod 6 MG Oral Tablet [Ponvory]) / 1 (ponesimod 7 MG Oral Tablet [Ponvory]) / 1 (ponesimod 8 MG Oral Tablet [Ponvory]) / 1 (ponesimod 9 MG Oral Tablet [Ponvory]) } Pack [Ponvory 14 Day] averages Tier 4.1 across Part D plans, ranging from Tier 1 to Tier 5.

Does {3 (ponesimod 10 MG Oral Tablet [Ponvory]) / 2 (ponesimod 2 MG Oral Tablet [Ponvory]) / 2 (ponesimod 3 MG Oral Tablet [Ponvory]) / 2 (ponesimod 4 MG Oral Tablet [Ponvory]) / 1 (ponesimod 5 MG Oral Tablet [Ponvory]) / 1 (ponesimod 6 MG Oral Tablet [Ponvory]) / 1 (ponesimod 7 MG Oral Tablet [Ponvory]) / 1 (ponesimod 8 MG Oral Tablet [Ponvory]) / 1 (ponesimod 9 MG Oral Tablet [Ponvory]) } Pack [Ponvory 14 Day] require prior authorization?

100% of Part D formularies require prior authorization for {3 (ponesimod 10 MG Oral Tablet [Ponvory]) / 2 (ponesimod 2 MG Oral Tablet [Ponvory]) / 2 (ponesimod 3 MG Oral Tablet [Ponvory]) / 2 (ponesimod 4 MG Oral Tablet [Ponvory]) / 1 (ponesimod 5 MG Oral Tablet [Ponvory]) / 1 (ponesimod 6 MG Oral Tablet [Ponvory]) / 1 (ponesimod 7 MG Oral Tablet [Ponvory]) / 1 (ponesimod 8 MG Oral Tablet [Ponvory]) / 1 (ponesimod 9 MG Oral Tablet [Ponvory]) } Pack [Ponvory 14 Day]. Step therapy: 0%. Quantity limits: 58.3%.

How much does Medicare spend on {3 (ponesimod 10 MG Oral Tablet [Ponvory]) / 2 (ponesimod 2 MG Oral Tablet [Ponvory]) / 2 (ponesimod 3 MG Oral Tablet [Ponvory]) / 2 (ponesimod 4 MG Oral Tablet [Ponvory]) / 1 (ponesimod 5 MG Oral Tablet [Ponvory]) / 1 (ponesimod 6 MG Oral Tablet [Ponvory]) / 1 (ponesimod 7 MG Oral Tablet [Ponvory]) / 1 (ponesimod 8 MG Oral Tablet [Ponvory]) / 1 (ponesimod 9 MG Oral Tablet [Ponvory]) } Pack [Ponvory 14 Day]?

In 2023, total Medicare Part D spending on {3 (ponesimod 10 MG Oral Tablet [Ponvory]) / 2 (ponesimod 2 MG Oral Tablet [Ponvory]) / 2 (ponesimod 3 MG Oral Tablet [Ponvory]) / 2 (ponesimod 4 MG Oral Tablet [Ponvory]) / 1 (ponesimod 5 MG Oral Tablet [Ponvory]) / 1 (ponesimod 6 MG Oral Tablet [Ponvory]) / 1 (ponesimod 7 MG Oral Tablet [Ponvory]) / 1 (ponesimod 8 MG Oral Tablet [Ponvory]) / 1 (ponesimod 9 MG Oral Tablet [Ponvory]) } Pack [Ponvory 14 Day] was $8,307,094, covering 99 beneficiaries. The average spend per beneficiary was $83,910.04.

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