Medicare Part D coverage · C1 · RxCUI 1599841
C1 esterase inhibitor (recombinant) 2100 UNT Injection [Ruconest]
Per the CMS 2026 Part D formulary file, C1 esterase inhibitor (recombinant) 2100 UNT Injection [Ruconest] is covered by 5 Medicare Part D plans (0.1% of enrollable products), averaging Tier 4, with prior authorization required on 33.3% of covering formularies.
- 0.1%
- Plan coverage
- 5
- Plans covering
- T4
- Avg tier
- 33.3%
- Prior auth required
What the CMS Formulary Data Shows for C1 esterase inhibitor (recombinant) 2100 UNT Injection [Ruconest]
Per the CMS 2026 Part D formulary file, C1 esterase inhibitor (recombinant) 2100 UNT Injection [Ruconest] (RxNorm concept RXCUI 1599841, generic name C1) appears on 3 distinct formulary files spanning 5 Medicare Part D plan offerings - 0.1% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 4.
Real-world access to C1 esterase inhibitor (recombinant) 2100 UNT Injection [Ruconest] depends on utilization management as much as tier placement: 33.3% 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 191 Part D beneficiaries filled C1 esterase inhibitor (recombinant) 2100 UNT Injection [Ruconest] in 2023, with total plan-and-beneficiary spending of $78,929,250 and an average per-beneficiary annual cost of $413,242.15. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry C1 esterase inhibitor (recombinant) 2100 UNT Injection [Ruconest] today.
Coverage Details
- Formularies covering
- 3
- Plans covering
- 5
- Coverage rate
- 0.1%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 33.3% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 191
- Total spending
- $78,929,250
- Avg per beneficiary
- $413,242.15
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering C1 esterase inhibitor (recombinant) 2100 UNT Injection [Ruconest]
5 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| Samaritan Dual Advantage (HMO D-SNP) | Samaritan Health Plans, Inc. | T5 | Yes | $10.50 | OR |
| Fallon Medicare Plus Orange (HMO) | Fallon Community Health Plan | T6 | No | $0 | MA |
| Fallon Medicare Plus Green (HMO) | Fallon Community Health Plan | T6 | No | $56.40 | MA |
| Fallon Medicare Plus Blue (HMO) | Fallon Community Health Plan | T6 | No | $72.10 | MA |
Frequently Asked Questions
Is C1 esterase inhibitor (recombinant) 2100 UNT Injection [Ruconest] covered by Medicare Part D?
Yes, C1 esterase inhibitor (recombinant) 2100 UNT Injection [Ruconest] is covered by 5 Medicare Part D plans (0.1% of all Part D formularies).
What tier is C1 esterase inhibitor (recombinant) 2100 UNT Injection [Ruconest] on Medicare Part D plans?
C1 esterase inhibitor (recombinant) 2100 UNT Injection [Ruconest] averages Tier 4 across Part D plans, ranging from Tier 1 to Tier 6.
Does C1 esterase inhibitor (recombinant) 2100 UNT Injection [Ruconest] require prior authorization?
33.3% of Part D formularies require prior authorization for C1 esterase inhibitor (recombinant) 2100 UNT Injection [Ruconest]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on C1 esterase inhibitor (recombinant) 2100 UNT Injection [Ruconest]?
In 2023, total Medicare Part D spending on C1 esterase inhibitor (recombinant) 2100 UNT Injection [Ruconest] was $78,929,250, covering 191 beneficiaries. The average spend per beneficiary was $413,242.15.
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
- dihydroergotamine mesylate 0.5 MG/ACTUAT Metered Dose Nasal Spray T4
- 0.5 ML darbepoetin alfa 0.2 MG/ML Prefilled Syringe [Aranesp] T4
- amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia] T4
- timolol hemihydrate 5 MG/ML Ophthalmic Solution [Betimol] T4
- deflazacort 18 MG Oral Tablet [Jaythari] T4
- bepotastine besilate 15 MG/ML Ophthalmic Solution [Bepreve] T4
Similar prior-authorization rate
- meperidine hydrochloride 50 MG Oral Tablet 33.3% PA
- chlordiazepoxide hydrochloride 5 MG / clidinium bromide 2.5 MG Oral Capsule 33.3% PA
- sevelamer carbonate 800 MG Oral Tablet 33.3% PA
- promethazine hydrochloride 25 MG Rectal Suppository 33.3% PA
- aspirin 325 MG / butalbital 50 MG / caffeine 40 MG / codeine phosphate 30 MG Oral Capsule [Ascomp] 33.3% PA
- pretomanid 200 MG Oral Tablet 33.3% PA