Medicare Part D coverage · {4 · RxCUI 2682430
{4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack]
Per the CMS 2026 Part D formulary file, {4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack] is covered by 2,895 Medicare Part D plans (57.3% of enrollable products), averaging Tier 4.2, with prior authorization required on 99.6% of covering formularies.
- 57.3%
- Plan coverage
- 2,895
- Plans covering
- T4.2
- Avg tier
- 99.6%
- Prior auth required
What the CMS Formulary Data Shows for {4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack]
Per the CMS 2026 Part D formulary file, {4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack] (RxNorm concept RXCUI 2682430, generic name {4) appears on 255 distinct formulary files spanning 2,895 Medicare Part D plan offerings - 57.3% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.2.
Real-world access to {4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack] depends on utilization management as much as tier placement: 99.6% of covering formularies require prior authorization. 0% require step therapy. 70.6% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 26,811 Part D beneficiaries filled {4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack] in 2023, with total plan-and-beneficiary spending of $876,590,721 and an average per-beneficiary annual cost of $32,695.19. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry {4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack] today.
Coverage Details
- Formularies covering
- 255
- Plans covering
- 2,895
- Coverage rate
- 57.3%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 99.6% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 70.6% of formularies
2023 Medicare Spending
- Beneficiaries
- 26,811
- Total spending
- $876,590,721
- Avg per beneficiary
- $32,695.19
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering {4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack]
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 | Yes | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | Yes | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | Yes | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | Yes | $0 | NJ |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | Yes | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | Yes | $0 | GA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | Yes | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | Yes | $0 | AL |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | Yes | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | Yes | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| 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 |
Show the next 30 plans
| 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 |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | Yes | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | Yes | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $0 | MO |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $0 | AR |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | Yes | $0 | WI |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Advance (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Plus (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | Yes | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $0 | DE |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | Yes | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | Yes | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | Yes | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | Yes | $0 | MA |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | Yes | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is {4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack] covered by Medicare Part D?
Yes, {4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack] is covered by 2,895 Medicare Part D plans (57.3% of all Part D formularies).
What tier is {4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack] on Medicare Part D plans?
{4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 5.
Does {4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack] require prior authorization?
99.6% of Part D formularies require prior authorization for {4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack]. Step therapy: 0%. Quantity limits: 70.6%.
How much does Medicare spend on {4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack]?
In 2023, total Medicare Part D spending on {4 (apremilast 10 MG Oral Tablet [Otezla]) / 51 (apremilast 20 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20 Starter Pack] was $876,590,721, covering 26,811 beneficiaries. The average spend per beneficiary was $32,695.19.
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
- 24 HR selegiline 0.25 MG/HR Transdermal System [Emsam] T4.2
- lotilaner 2.5 MG/ML Ophthalmic Solution [Xdemvy] T4.2
- glutamine 5000 MG Powder for Oral Solution T4.2
- 1.7 ML denosumab-bbdz 70 MG/ML Injection [Wyost] T4.2
- apremilast 20 MG Oral Tablet [Otezla] T4.2
- 0.1 ML adalimumab 100 MG/ML Prefilled Syringe [Humira] T4.2
Similar prior-authorization rate
- granisetron 1 MG Oral Tablet 99.6% PA
- budesonide 0.5 MG/ML Inhalation Suspension 99.6% PA
- dextromethorphan hydrobromide 20 MG / quinidine sulfate 10 MG Oral Capsule [Nuedexta] 99.6% PA
- {7 (24 HR deutetrabenazine 12 MG Extended Release Oral Tablet [Austedo]) / 7 (24 HR deutetrabenazine 18 MG Extended Release Oral Tablet [Austedo]) / 7 (24 HR deutetrabenazine 24 MG Extended Release Oral Tablet [Austedo]) / 7 (24 HR deutetrabenazine 30 MG Extended Release Oral Tablet [Austedo]) } Pack [Austedo XR Once Daily, 4 Week Titration Pack, 12 MG / 18 MG / 24 MG / 30 MG] 99.6% PA
- glecaprevir 100 MG / pibrentasvir 40 MG Oral Tablet [Mavyret] 99.6% PA
- glecaprevir 50 MG / pibrentasvir 20 MG Oral Pellet [Mavyret] 99.6% PA