Medicare Part D coverage · 3.5 · RxCUI 2725610
3.5 ML elamipretide 80 MG/ML Injection [Forzinity]
Per the CMS 2026 Part D formulary file, 3.5 ML elamipretide 80 MG/ML Injection [Forzinity] is covered by 36 Medicare Part D plans (0.7% of enrollable products), averaging Tier 5, with prior authorization required on 100% of covering formularies.
- 0.7%
- Plan coverage
- 36
- Plans covering
- T5
- Avg tier
- 100%
- Prior auth required
What the CMS Formulary Data Shows for 3.5 ML elamipretide 80 MG/ML Injection [Forzinity]
Per the CMS 2026 Part D formulary file, 3.5 ML elamipretide 80 MG/ML Injection [Forzinity] (RxNorm concept RXCUI 2725610, generic name 3.5) appears on 5 distinct formulary files spanning 36 Medicare Part D plan offerings - 0.7% 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 3.5 ML elamipretide 80 MG/ML Injection [Forzinity] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 80% 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 3.5 ML elamipretide 80 MG/ML Injection [Forzinity] today.
Coverage Details
- Formularies covering
- 5
- Plans covering
- 36
- Coverage rate
- 0.7%
- 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
- 80% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 3.5 ML elamipretide 80 MG/ML Injection [Forzinity]
36 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Health First Rewards H1099-014 (HMO) | Health First Health Plans | T5 | Yes | $0 | FL |
| Health First SunSaver H1099-016 (HMO) | Health First Health Plans | T5 | Yes | $0 | FL |
| Health First Complete Care H1099-023 (HMO) | Health First Health Plans | T5 | Yes | $0 | FL |
| Health First Emerald Plus H1099-024 (HMO) | Health First Health Plans | T5 | Yes | $0 | FL |
| Health First Premier Access H1099-025 (HMO-POS) | Health First Health Plans | T5 | Yes | $0 | FL |
| Health First Emerald Plus H1099-026 (HMO) | Health First Health Plans | T5 | Yes | $0 | FL |
| Health First Premier Access H1099-027 (HMO-POS) | Health First Health Plans | T5 | Yes | $0 | FL |
| Health First Emerald Plus H1099-028 (HMO) | Health First Health Plans | T5 | Yes | $0 | FL |
| Prominence Plus (HMO) | Prominence Healthfirst | T5 | Yes | $0 | NV |
| Prominence Plus (HMO) | Prominence Healthfirst | T5 | Yes | $0 | NV |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst | T5 | Yes | $0 | NV |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst | T5 | Yes | $0 | NV |
| Prominence Giveback (HMO) | Prominence Healthfirst | T5 | Yes | $0 | NV |
| Prominence Plus (HMO) | Prominence Healthfirst OF Florida Inc | T5 | Yes | $0 | FL |
| Prominence Giveback (HMO) | Prominence Healthfirst OF Florida Inc | T5 | Yes | $0 | FL |
| Prominence Plus (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Plus (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Extra Help (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Beyond (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
Show the next 16 plans
| Prominence Giveback (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Giveback (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Beyond (HMO-POS) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst OF Florida Inc | T5 | Yes | $0 | FL |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst | T5 | Yes | $0 | NV |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst OF Florida Inc | T5 | Yes | $0 | FL |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Diabetes and Heart Care Plus (HMO C-SNP) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Extra Help (HMO) | Prominence Healthfirst | T5 | Yes | $4.20 | NV |
| Prominence Extra Help (HMO) | Prominence Healthfirst OF Florida Inc | T5 | Yes | $4.80 | FL |
| Prominence Extra Help (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $4.80 | TX |
| Prominence Extra Help (HMO) | Prominence Healthfirst | T5 | Yes | $9.50 | NV |
| Health First Value H1099-006 (HMO) | Health First Health Plans | T5 | Yes | $15.00 | FL |
| Health First Classic H1099-001 (HMO-POS) | Health First Health Plans | T5 | Yes | $49.40 | FL |
Frequently Asked Questions
Is 3.5 ML elamipretide 80 MG/ML Injection [Forzinity] covered by Medicare Part D?
Yes, 3.5 ML elamipretide 80 MG/ML Injection [Forzinity] is covered by 36 Medicare Part D plans (0.7% of all Part D formularies).
What tier is 3.5 ML elamipretide 80 MG/ML Injection [Forzinity] on Medicare Part D plans?
3.5 ML elamipretide 80 MG/ML Injection [Forzinity] averages Tier 5 across Part D plans, ranging from Tier 5 to Tier 5.
Does 3.5 ML elamipretide 80 MG/ML Injection [Forzinity] require prior authorization?
100% of Part D formularies require prior authorization for 3.5 ML elamipretide 80 MG/ML Injection [Forzinity]. Step therapy: 0%. Quantity limits: 80%.
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
- 0.8 ML adalimumab-adaz 100 MG/ML Auto-Injector T5
- metronidazole 10 MG/ML Topical Cream [Noritate] T5
- 1 ML ustekinumab-ttwe 90 MG/ML Prefilled Syringe T5
- formoterol fumarate 0.01 MG/ML Inhalation Solution [Perforomist] T5
- deferiprone 1000 MG Oral Tablet [Ferriprox] T5
- ruxolitinib 15 MG/ML Topical Cream [Opzelura] T5
Similar prior-authorization rate
- azathioprine 50 MG Oral Tablet 100% PA
- 0.5 ML hepatitis B surface antigen vaccine 0.04 MG/ML Prefilled Syringe [Heplisav-B] 100% PA
- 0.5 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] 100% PA
- 1 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] 100% PA
- sotagliflozin 200 MG Oral Tablet [Inpefa] 100% PA
- mycophenolate mofetil 250 MG Oral Capsule 100% PA