Medicare Part D coverage · 3.5 · RxCUI 2570419
3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega]
Per the CMS 2026 Part D formulary file, 3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega] is covered by 4,981 Medicare Part D plans (98.6% of enrollable products), averaging Tier 4.3, with prior authorization required on 7% of covering formularies.
- 98.6%
- Plan coverage
- 4,981
- Plans covering
- T4.3
- Avg tier
- 7%
- Prior auth required
What the CMS Formulary Data Shows for 3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega]
Per the CMS 2026 Part D formulary file, 3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega] (RxNorm concept RXCUI 2570419, generic name 3.5) appears on 299 distinct formulary files spanning 4,981 Medicare Part D plan offerings - 98.6% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.3.
Real-world access to 3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega] depends on utilization management as much as tier placement: 7% of covering formularies require prior authorization. 6.4% require step therapy. 86% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 2,964 Part D beneficiaries filled 3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega] in 2023, with total plan-and-beneficiary spending of $5,169,576 and an average per-beneficiary annual cost of $1,744.12. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega] today.
Coverage Details
- Formularies covering
- 299
- Plans covering
- 4,981
- Coverage rate
- 98.6%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 7% of formularies
- Step therapy required
- 6.4% of formularies
- Quantity limits
- 86% of formularies
2023 Medicare Spending
- Beneficiaries
- 2,964
- Total spending
- $5,169,576
- Avg per beneficiary
- $1,744.12
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega]
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 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | No | $0 | FL |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $0 | NJ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | No | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | No | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | No | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | No | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | No | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | No | $0 | NY |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | No | $0 | GA |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
Show the next 30 plans
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | No | $0 | MI |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | No | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | No | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | No | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | No | $0 | CA |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | No | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | No | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | No | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | No | $0 | NY |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $0 | MO |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | No | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | No | $0 | AR |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega] covered by Medicare Part D?
Yes, 3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega] is covered by 4,981 Medicare Part D plans (98.6% of all Part D formularies).
What tier is 3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega] on Medicare Part D plans?
3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega] averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 5.
Does 3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega] require prior authorization?
7% of Part D formularies require prior authorization for 3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega]. Step therapy: 6.4%. Quantity limits: 86%.
How much does Medicare spend on 3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega]?
In 2023, total Medicare Part D spending on 3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega] was $5,169,576, covering 2,964 beneficiaries. The average spend per beneficiary was $1,744.12.
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
- {4 (selinexor 80 MG Oral Tablet [Xpovio]) } Pack [Xpovio 80 MG Once Weekly Carton-80 MG Tablet] T4.3
- 5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega] T4.3
- ceftaroline fosamil 600 MG Injection T4.3
- 0.5 ML ustekinumab 90 MG/ML Prefilled Syringe T4.3
- 1 ML ustekinumab 90 MG/ML Prefilled Syringe T4.3
- sofosbuvir 200 MG / velpatasvir 50 MG Oral Tablet [Epclusa] T4.3
Similar prior-authorization rate
- paroxetine mesylate 7.5 MG Oral Capsule 7.1% PA
- 24 HR donepezil hydrochloride 10 MG / memantine hydrochloride 14 MG Extended Release Oral Capsule [Namzaric] 6.9% PA
- prednisolone 10 MG Disintegrating Oral Tablet 7.1% PA
- acetohydroxamic acid 250 MG Oral Tablet [Lithostat] 7.1% PA
- mometasone furoate 0.025 MG/ACTUAT / olopatadine hydrochloride 0.665 MG/ACTUAT Metered Dose Nasal Spray [Ryaltris] 7.1% PA
- sucroferric oxyhydroxide 500 MG Chewable Tablet [Velphoro] 7.1% PA