Medicare Part D coverage · caplacizumab-yhdp · RxCUI 2110618
caplacizumab-yhdp 11 MG Injection [Cablivi]
Per the CMS 2026 Part D formulary file, caplacizumab-yhdp 11 MG Injection [Cablivi] is covered by 1,276 Medicare Part D plans (25.3% of enrollable products), averaging Tier 4.3, with prior authorization required on 93.1% of covering formularies.
- 25.3%
- Plan coverage
- 1,276
- Plans covering
- T4.3
- Avg tier
- 93.1%
- Prior auth required
What the CMS Formulary Data Shows for caplacizumab-yhdp 11 MG Injection [Cablivi]
Per the CMS 2026 Part D formulary file, caplacizumab-yhdp 11 MG Injection [Cablivi] (RxNorm concept RXCUI 2110618, generic name caplacizumab-yhdp) appears on 87 distinct formulary files spanning 1,276 Medicare Part D plan offerings - 25.3% 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 4.3.
Real-world access to caplacizumab-yhdp 11 MG Injection [Cablivi] depends on utilization management as much as tier placement: 93.1% of covering formularies require prior authorization. 0% require step therapy. 52.9% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 48 Part D beneficiaries filled caplacizumab-yhdp 11 MG Injection [Cablivi] in 2023, with total plan-and-beneficiary spending of $20,162,189 and an average per-beneficiary annual cost of $420,045.60. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry caplacizumab-yhdp 11 MG Injection [Cablivi] today.
Coverage Details
- Formularies covering
- 87
- Plans covering
- 1,276
- Coverage rate
- 25.3%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 93.1% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 52.9% of formularies
2023 Medicare Spending
- Beneficiaries
- 48
- Total spending
- $20,162,189
- Avg per beneficiary
- $420,045.60
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering caplacizumab-yhdp 11 MG Injection [Cablivi]
5 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T5 | Yes | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T5 | Yes | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering caplacizumab-yhdp 11 MG Injection [Cablivi]
95 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 |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $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 |
| 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 |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
Show the next 30 plans
| 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 |
| 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 |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | Yes | $17.00 | AZ |
| WellSense Added Value (HMO) | Boston Medical Center Health Plan, Inc. | T1 | Yes | $21.70 | NH |
| 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 |
| Hamaspik Medicare Select (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $34.50 | NY |
| 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 |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T4 | Yes | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T4 | Yes | $0 | NY |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS Choice | T4 | Yes | $51.60 | NY |
| UHC Dual Complete IA-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T5 | Yes | $0 | IA |
| UHC Dual Complete MO-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T5 | Yes | $0 | MO |
| UHC Dual Complete NE-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T5 | Yes | $0 | NE |
| UHC Dual Complete KS-S001 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T5 | Yes | $0 | KS |
| UHC Dual Complete MO-S3 (HMO-POS D-SNP) | Unitedhealthcare OF Wisconsin, Inc. | T5 | Yes | $0 | MO |
Showing top 50 of 95 plans.
Frequently Asked Questions
Is caplacizumab-yhdp 11 MG Injection [Cablivi] covered by Medicare Part D?
Yes, caplacizumab-yhdp 11 MG Injection [Cablivi] is covered by 1,276 Medicare Part D plans (25.3% of all Part D formularies).
What tier is caplacizumab-yhdp 11 MG Injection [Cablivi] on Medicare Part D plans?
caplacizumab-yhdp 11 MG Injection [Cablivi] averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 5.
Does caplacizumab-yhdp 11 MG Injection [Cablivi] require prior authorization?
93.1% of Part D formularies require prior authorization for caplacizumab-yhdp 11 MG Injection [Cablivi]. Step therapy: 0%. Quantity limits: 52.9%.
How much does Medicare spend on caplacizumab-yhdp 11 MG Injection [Cablivi]?
In 2023, total Medicare Part D spending on caplacizumab-yhdp 11 MG Injection [Cablivi] was $20,162,189, covering 48 beneficiaries. The average spend per beneficiary was $420,045.60.
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
- 1 ML epoetin alfa 40000 UNT/ML Injection [Procrit] T4.3
- epoetin alfa 20000 UNT/ML Injectable Solution [Procrit] T4.3
- 28 ACTUAT teriparatide 0.02 MG/ACTUAT Pen Injector [Bonsity] T4.3
- perampanel 4 MG Oral Tablet [FYCOMPA] T4.3
- caffeine 100 MG / ergotamine tartrate 2 MG Rectal Suppository [Migergot] T4.3
- {28 (alpelisib 200 MG Oral Tablet [Vijoice]) / 28 (alpelisib 50 MG Oral Tablet [Vijoice]) } Pack [Vijoice 250 MG 28 Day] T4.3
Similar prior-authorization rate
- 0.6 ML pegfilgrastim-bmez 10 MG/ML Prefilled Syringe [Ziextenzo] 93.1% PA
- insulin lispro 100 UNT/ML Injectable Solution [Admelog] 93% PA
- 0.5 ML tbo-filgrastim 0.6 MG/ML Prefilled Syringe [Granix] 93% PA
- 0.8 ML tbo-filgrastim 0.6 MG/ML Prefilled Syringe [Granix] 93% PA
- {28 (alpelisib 50 MG Oral Granules [Vijoice]) } Pack [Vijoice 50 MG Granules 28 Day] 93% PA
- 0.4 ML adalimumab-adbm 100 MG/ML Prefilled Syringe 92.9% PA