Medicare Part D coverage · 5 · RxCUI 2712088
5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo]
Per the CMS 2026 Part D formulary file, 5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo] is covered by 1,345 Medicare Part D plans (26.6% of enrollable products), averaging Tier 4.2, with prior authorization required on 97% of covering formularies.
- 26.6%
- Plan coverage
- 1,345
- Plans covering
- T4.2
- Avg tier
- 97%
- Prior auth required
What the CMS Formulary Data Shows for 5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo]
Per the CMS 2026 Part D formulary file, 5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo] (RxNorm concept RXCUI 2712088, generic name 5) appears on 66 distinct formulary files spanning 1,345 Medicare Part D plan offerings - 26.6% 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 4.2.
Real-world access to 5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo] depends on utilization management as much as tier placement: 97% of covering formularies require prior authorization. 0% require step therapy. 50% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 86 Part D beneficiaries filled 5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo] in 2023, with total plan-and-beneficiary spending of $8,981,322 and an average per-beneficiary annual cost of $104,433.97. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo] today.
Coverage Details
- Formularies covering
- 66
- Plans covering
- 1,345
- Coverage rate
- 26.6%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 97% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 50% of formularies
2023 Medicare Spending
- Beneficiaries
- 86
- Total spending
- $8,981,322
- Avg per beneficiary
- $104,433.97
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering 5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo]
59 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $6.70 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $32.60 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $35.70 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $48.40 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $50.00 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $50.00 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $50.40 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $52.60 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $54.50 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $56.30 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $56.30 | - |
Show the next 30 plans
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $59.70 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $59.90 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $60.60 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $61.70 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $62.60 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $65.40 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $65.70 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $65.70 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $66.40 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $66.50 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $66.60 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $66.60 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $70.00 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $70.60 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $70.70 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $70.70 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $71.20 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $71.20 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $74.00 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $74.30 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $77.10 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $77.50 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $78.00 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $78.20 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $87.20 | - |
| HealthSpring Extra Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $91.60 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $95.60 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $104.20 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $109.30 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T4 | Yes | No | $109.50 | - |
Showing top 50 of 59 plans.
Medicare Advantage Plans (MA-PD) Covering 5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo]
41 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| 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 |
| 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 |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | Yes | $4.80 | TX |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | Yes | $8.80 | MI |
Show the next 21 plans
| 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 |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Illinois | 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 |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $32.70 | PA |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $32.70 | PA |
| 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 |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | Yes | $36.20 | NC |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | Yes | $36.20 | NC |
| Provider Partners Indiana Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | Yes | $38.40 | IN |
| Provider Partners Indiana Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | Yes | $38.40 | IN |
| Provider Partners Kentucky Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Kentucky | T1 | Yes | $38.40 | KY |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | Yes | $40.00 | NJ |
| Provider Partners Missouri Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $43.00 | MO |
| Provider Partners Missouri Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $43.00 | MO |
| 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 |
Frequently Asked Questions
Is 5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo] covered by Medicare Part D?
Yes, 5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo] is covered by 1,345 Medicare Part D plans (26.6% of all Part D formularies).
What tier is 5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo] on Medicare Part D plans?
5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 5.
Does 5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo] require prior authorization?
97% of Part D formularies require prior authorization for 5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo]. Step therapy: 0%. Quantity limits: 50%.
How much does Medicare spend on 5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo]?
In 2023, total Medicare Part D spending on 5 ML efgartigimod alfa-qvfc 200 MG/ML / hyaluronidase-qvfc 2000 UNT/ML Prefilled Syringe [Vyvgart Hytrulo] was $8,981,322, covering 86 beneficiaries. The average spend per beneficiary was $104,433.97.
Read our methodology - how this data is sourced, computed, and verified.
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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.
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