Medicare Part D coverage · {4 · RxCUI 2122659
{4 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 4 Tablet Pack]
Per the CMS 2026 Part D formulary file, {4 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 4 Tablet Pack] is covered by 172 Medicare Part D plans (3.4% of enrollable products), averaging Tier 4, with prior authorization required on 94.1% of covering formularies.
- 3.4%
- Plan coverage
- 172
- Plans covering
- T4
- Avg tier
- 94.1%
- Prior auth required
What the CMS Formulary Data Shows for {4 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 4 Tablet Pack]
Per the CMS 2026 Part D formulary file, {4 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 4 Tablet Pack] (RxNorm concept RXCUI 2122659, generic name {4) appears on 68 distinct formulary files spanning 172 Medicare Part D plan offerings - 3.4% 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.
Real-world access to {4 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 4 Tablet Pack] depends on utilization management as much as tier placement: 94.1% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 1,130 Part D beneficiaries filled {4 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 4 Tablet Pack] in 2023, with total plan-and-beneficiary spending of $156,344,544 and an average per-beneficiary annual cost of $138,358.00. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry {4 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 4 Tablet Pack] today.
Coverage Details
- Formularies covering
- 68
- Plans covering
- 172
- Coverage rate
- 3.4%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 94.1% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,130
- Total spending
- $156,344,544
- Avg per beneficiary
- $138,358.00
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering {4 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 4 Tablet Pack]
100 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 |
| 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 |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $0 | KY, TN |
| 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 |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | Yes | $17.00 | AZ |
| Alterwood Advantage Dual Value (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $31.20 | MD |
| Valor Health Plan (HMO I-SNP) | TSG Guard, Inc. | T1 | Yes | $31.40 | OH |
Show the next 30 plans
| WV Senior Advantage (HMO I-SNP) | West Virginia Senior Advantage, Inc. | T1 | Yes | $32.70 | WV |
| Abilis Health (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $35.90 | KY, TN |
| CommuniCare Advantage ISNP (HMO I-SNP) | OH CHS SNP Inc. | T1 | Yes | $38.40 | IN, MD, OH |
| Nascentia Skilled Nursing Facility (HMO I-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $58.80 | NY |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T2 | Yes | $0 | CA |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T4 | Yes | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T4 | Yes | $0 | NY |
| Leon MediExtra (HMO) | Leon Health, Inc. | T4 | Yes | $0 | FL |
| Leon MediDual (HMO D-SNP) | Leon Health, Inc. | T4 | Yes | $0 | FL |
| Leon MediMore (HMO) | Leon Health, Inc. | T4 | Yes | $0 | FL |
| Leon MediMax (HMO D-SNP) | Leon Health, Inc. | T4 | Yes | $0 | FL |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS Choice | T4 | Yes | $51.60 | NY |
| 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 |
| CenCal CareConnect (HMO D-SNP) | Santa Barbara SAN Luis Obispo Regional Health Authority DBA | T5 | Yes | $0 | CA |
| SummaCare Medicare Topaz (HMO) | Summacare Inc. | T5 | Yes | $0 | OH |
| SummaCare Medicare Quartz (HMO) | Summacare Inc. | T5 | Yes | $0 | OH |
| IEHP DualChoice (HMO D-SNP) | Inland Empire Health Plan | 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 |
| Astiva Health Savings Plan (HMO) | Astiva Health, Inc. | T5 | Yes | $0 | CA |
| Astiva Health C-SNP Deluxe (HMO C-SNP) | Astiva Health, Inc. | T5 | Yes | $0 | CA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is {4 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 4 Tablet Pack] covered by Medicare Part D?
Yes, {4 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 4 Tablet Pack] is covered by 172 Medicare Part D plans (3.4% of all Part D formularies).
What tier is {4 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 4 Tablet Pack] on Medicare Part D plans?
{4 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 4 Tablet Pack] averages Tier 4 across Part D plans, ranging from Tier 1 to Tier 5.
Does {4 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 4 Tablet Pack] require prior authorization?
94.1% of Part D formularies require prior authorization for {4 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 4 Tablet Pack]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on {4 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 4 Tablet Pack]?
In 2023, total Medicare Part D spending on {4 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 4 Tablet Pack] was $156,344,544, covering 1,130 beneficiaries. The average spend per beneficiary was $138,358.00.
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
- risperidone 50 MG Injection T4
- mavacamten 10 MG Oral Capsule [Camzyos] T4
- 0.2 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo] T4
- 0.4 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo] T4
- 0.8 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo] T4
- {12 (siponimod 0.25 MG Oral Tablet [Mayzent]) } Pack [Mayzent 2 MG Starter Pack] T4
Similar prior-authorization rate
- deferasirox 360 MG Oral Tablet 94.1% PA
- 1.5 ML brodalumab 140 MG/ML Prefilled Syringe [Siliq] 94.1% PA
- 0.6 ML pegfilgrastim-pbbk 10 MG/ML Prefilled Syringe [Fylnetra] 94.1% PA
- {10 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 10 Tablet Pack] 94.1% PA
- {5 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 5 Tablet Pack] 94.1% PA
- {6 (cladribine 10 MG Oral Tablet [Mavenclad]) } Pack [Mavenclad 6 Tablet Pack] 94.1% PA