Medicare Part D coverage · {4 · RxCUI 2642214
{4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) / 21 (ozanimod 0.92 MG Oral Capsule [Zeposia]) } Pack [Zeposia 28-Day Starter Kit]
Per the CMS 2026 Part D formulary file, {4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) / 21 (ozanimod 0.92 MG Oral Capsule [Zeposia]) } Pack [Zeposia 28-Day Starter Kit] is covered by 195 Medicare Part D plans (3.9% of enrollable products), averaging Tier 3.7, with prior authorization required on 97.7% of covering formularies.
- 3.9%
- Plan coverage
- 195
- Plans covering
- T3.7
- Avg tier
- 97.7%
- Prior auth required
What the CMS Formulary Data Shows for {4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) / 21 (ozanimod 0.92 MG Oral Capsule [Zeposia]) } Pack [Zeposia 28-Day Starter Kit]
Per the CMS 2026 Part D formulary file, {4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) / 21 (ozanimod 0.92 MG Oral Capsule [Zeposia]) } Pack [Zeposia 28-Day Starter Kit] (RxNorm concept RXCUI 2642214, generic name {4) appears on 44 distinct formulary files spanning 195 Medicare Part D plan offerings - 3.9% 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 3.7.
Real-world access to {4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) / 21 (ozanimod 0.92 MG Oral Capsule [Zeposia]) } Pack [Zeposia 28-Day Starter Kit] depends on utilization management as much as tier placement: 97.7% of covering formularies require prior authorization. 0% require step therapy. 86.4% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 1,034 Part D beneficiaries filled {4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) / 21 (ozanimod 0.92 MG Oral Capsule [Zeposia]) } Pack [Zeposia 28-Day Starter Kit] in 2023, with total plan-and-beneficiary spending of $62,945,499 and an average per-beneficiary annual cost of $60,875.72. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry {4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) / 21 (ozanimod 0.92 MG Oral Capsule [Zeposia]) } Pack [Zeposia 28-Day Starter Kit] today.
Coverage Details
- Formularies covering
- 44
- Plans covering
- 195
- Coverage rate
- 3.9%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 97.7% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 86.4% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,034
- Total spending
- $62,945,499
- Avg per beneficiary
- $60,875.72
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering {4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) / 21 (ozanimod 0.92 MG Oral Capsule [Zeposia]) } Pack [Zeposia 28-Day Starter Kit]
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 |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| 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 |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $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 |
| 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 |
Show the next 30 plans
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $0 | DE |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | Yes | $8.80 | MI |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $13.10 | PA |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Illinois, Inc. | T1 | Yes | $15.20 | IL |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $17.60 | PA |
| WellSense Added Value (HMO) | Boston Medical Center Health Plan, Inc. | T1 | Yes | $21.70 | NH |
| Highmark Health Options Duals Select (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $31.20 | DE |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Colorado, Inc. | T1 | Yes | $35.20 | CO |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF North Carolina, Inc. | T1 | Yes | $36.20 | NC |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | Yes | $40.00 | NJ |
| ElderServe Star (HMO I-SNP) | Elderserve Health, Inc. | T1 | Yes | $58.80 | NY |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF NEW York, Inc. | T1 | Yes | $58.80 | NY |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T2 | Yes | $0 | CA |
| Community Blue Medicare HMO Signature (HMO) | Highmark Western and Northeastern New York Inc. | T5 | Yes | $0 | NY |
| Community Blue Medicare HMO Merit (HMO) | Highmark Western and Northeastern New York Inc. | T5 | Yes | $0 | NY |
| Community Blue Medicare PPO Signature (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Complete Blue PPO Signature (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Complete Blue PPO Signature (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Complete Blue PPO Merit (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Complete Blue PPO Signature (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Complete Blue PPO Distinct (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Complete Blue Plus PPO Merit (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Community Blue Medicare PPO Signature (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Complete Blue PPO Merit (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Community Blue Medicare HMO Signature (HMO) | Highmark Choice Company | T5 | Yes | $0 | PA |
| Security Blue HMO-POS ValueRx (HMO-POS) | Highmark Choice Company | T5 | Yes | $0 | PA |
| Community Blue Medicare HMO Signature (HMO) | Highmark Choice Company | T5 | Yes | $0 | PA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is {4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) / 21 (ozanimod 0.92 MG Oral Capsule [Zeposia]) } Pack [Zeposia 28-Day Starter Kit] covered by Medicare Part D?
Yes, {4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) / 21 (ozanimod 0.92 MG Oral Capsule [Zeposia]) } Pack [Zeposia 28-Day Starter Kit] is covered by 195 Medicare Part D plans (3.9% of all Part D formularies).
What tier is {4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) / 21 (ozanimod 0.92 MG Oral Capsule [Zeposia]) } Pack [Zeposia 28-Day Starter Kit] on Medicare Part D plans?
{4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) / 21 (ozanimod 0.92 MG Oral Capsule [Zeposia]) } Pack [Zeposia 28-Day Starter Kit] averages Tier 3.7 across Part D plans, ranging from Tier 1 to Tier 5.
Does {4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) / 21 (ozanimod 0.92 MG Oral Capsule [Zeposia]) } Pack [Zeposia 28-Day Starter Kit] require prior authorization?
97.7% of Part D formularies require prior authorization for {4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) / 21 (ozanimod 0.92 MG Oral Capsule [Zeposia]) } Pack [Zeposia 28-Day Starter Kit]. Step therapy: 0%. Quantity limits: 86.4%.
How much does Medicare spend on {4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) / 21 (ozanimod 0.92 MG Oral Capsule [Zeposia]) } Pack [Zeposia 28-Day Starter Kit]?
In 2023, total Medicare Part D spending on {4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) / 21 (ozanimod 0.92 MG Oral Capsule [Zeposia]) } Pack [Zeposia 28-Day Starter Kit] was $62,945,499, covering 1,034 beneficiaries. The average spend per beneficiary was $60,875.72.
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
- Modified 24 HR metformin hydrochloride 500 MG Extended Release Oral Tablet T3.7
- ergotamine tartrate 2 MG Sublingual Tablet [Ergomar] T3.7
- sildenafil 10 MG/ML Oral Suspension T3.7
- somatropin 12 MG Cartridge [Humatrope] T3.7
- baclofen 5 MG/ML Oral Suspension T3.7
- nitrofurantoin 10 MG/ML Oral Suspension T3.7
Similar prior-authorization rate
- levalbuterol 0.417 MG/ML Inhalation Solution 97.7% PA
- zavegepant 10 MG Nasal Spray [Zavzpret] 97.8% PA
- alanine 8.8 MG/ML / arginine 4.89 MG/ML / glucose 100 MG/ML / glycine 4.38 MG/ML / histidine 2.04 MG/ML / isoleucine 2.55 MG/ML / leucine 3.11 MG/ML / lysine 2.47 MG/ML / methionine 1.7 MG/ML / phenylalanine 2.38 MG/ML / proline 2.89 MG/ML / serine 2.13 MG/ML / threonine 1.79 MG/ML / tryptophan 0.77 MG/ML / tyrosine 0.17 MG/ML / valine 2.47 MG/ML Injectable Solution [Clinimix 4.25/10] 97.8% PA
- alpha 1-proteinase inhibitor, human 1 MG Injection [Aralast] 97.8% PA
- alanine 8.8 MG/ML / arginine 4.89 MG/ML / glucose 50 MG/ML / glycine 4.38 MG/ML / histidine 2.04 MG/ML / isoleucine 2.55 MG/ML / leucine 3.11 MG/ML / lysine 2.47 MG/ML / methionine 1.7 MG/ML / phenylalanine 2.38 MG/ML / proline 2.89 MG/ML / serine 2.13 MG/ML / threonine 1.79 MG/ML / tryptophan 0.77 MG/ML / tyrosine 0.17 MG/ML / valine 2.47 MG/ML Injectable Solution [Clinimix 4.25/5] 97.8% PA
- alanine 10.4 MG/ML / arginine 5.75 MG/ML / glucose 200 MG/ML / glycine 5.15 MG/ML / histidine 2.4 MG/ML / isoleucine 3 MG/ML / leucine 3.65 MG/ML / lysine 2.9 MG/ML / methionine 2 MG/ML / phenylalanine 2.8 MG/ML / proline 3.4 MG/ML / serine 2.5 MG/ML / threonine 2.1 MG/ML / tryptophan 0.9 MG/ML / tyrosine 0.2 MG/ML / valine 2.9 MG/ML Injectable Solution [Clinimix 5/20] 97.8% PA