Medicare Part D coverage · ceftaroline fosamil · RxCUI 1040008
ceftaroline fosamil 400 MG Injection
Per the CMS 2026 Part D formulary file, ceftaroline fosamil 400 MG Injection is covered by 4,485 Medicare Part D plans (88.8% of enrollable products), averaging Tier 4.3, with prior authorization required on 2.7% of covering formularies.
- 88.8%
- Plan coverage
- 4,485
- Plans covering
- T4.3
- Avg tier
- 2.7%
- Prior auth required
What the CMS Formulary Data Shows for ceftaroline fosamil 400 MG Injection
Per the CMS 2026 Part D formulary file, ceftaroline fosamil 400 MG Injection (RxNorm concept RXCUI 1040008, generic name ceftaroline fosamil) appears on 293 distinct formulary files spanning 4,485 Medicare Part D plan offerings - 88.8% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 4.3.
Real-world access to ceftaroline fosamil 400 MG Injection depends on utilization management as much as tier placement: 2.7% 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 887 Part D beneficiaries filled ceftaroline fosamil 400 MG Injection in 2023, with total plan-and-beneficiary spending of $11,267,093 and an average per-beneficiary annual cost of $12,702.47. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry ceftaroline fosamil 400 MG Injection today.
Coverage Details
- Formularies covering
- 293
- Plans covering
- 4,485
- Coverage rate
- 88.8%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 2.7% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 887
- Total spending
- $11,267,093
- Avg per beneficiary
- $12,702.47
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering ceftaroline fosamil 400 MG Injection
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 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | No | $0 | FL |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | No | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | No | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | No | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | No | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | No | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | No | $0 | NY |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | No | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | No | $0 | AL |
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T1 | No | $0 | CA |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | No | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
Show the next 30 plans
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | No | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | No | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | No | $0 | CA |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | No | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | No | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | No | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | No | $0 | NY |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $0 | MO |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | No | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | No | $0 | AR |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | No | $0 | CA |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | No | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | No | $0 | DE |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is ceftaroline fosamil 400 MG Injection covered by Medicare Part D?
Yes, ceftaroline fosamil 400 MG Injection is covered by 4,485 Medicare Part D plans (88.8% of all Part D formularies).
What tier is ceftaroline fosamil 400 MG Injection on Medicare Part D plans?
ceftaroline fosamil 400 MG Injection averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 6.
Does ceftaroline fosamil 400 MG Injection require prior authorization?
2.7% of Part D formularies require prior authorization for ceftaroline fosamil 400 MG Injection. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on ceftaroline fosamil 400 MG Injection?
In 2023, total Medicare Part D spending on ceftaroline fosamil 400 MG Injection was $11,267,093, covering 887 beneficiaries. The average spend per beneficiary was $12,702.47.
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
- lomustine 100 MG Oral Capsule [Gleostine] T4.3
- 0.67 ML anakinra 149 MG/ML Prefilled Syringe [Kineret] T4.3
- sofosbuvir 400 MG / velpatasvir 100 MG Oral Tablet [Epclusa] T4.3
- 0.25 ML somatropin 4.8 MG/ML Prefilled Syringe [Genotropin] T4.3
- olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi] T4.3
- deferasirox 360 MG Oral Granules T4.3
Similar prior-authorization rate
- pentosan polysulfate 100 MG Oral Capsule [Elmiron] 2.7% PA
- entecavir 0.05 MG/ML Oral Solution [Baraclude] 2.7% PA
- hydroxyurea 200 MG Oral Capsule [Droxia] 2.8% PA
- betaxolol 2.5 MG/ML Ophthalmic Suspension [Betoptic S] 2.8% PA
- bromocriptine 0.8 MG Oral Tablet [Cycloset] 2.6% PA
- varenicline 0.03 MG/ACTUAT Nasal Spray [Tyrvaya] 2.6% PA