Medicare Part D coverage · certolizumab pegol · RxCUI 795085
certolizumab pegol 200 MG Injection [Cimzia]
Per the CMS 2026 Part D formulary file, certolizumab pegol 200 MG Injection [Cimzia] is covered by 325 Medicare Part D plans (6.4% of enrollable products), averaging Tier 3.7, with prior authorization required on 100% of covering formularies.
- 6.4%
- Plan coverage
- 325
- Plans covering
- T3.7
- Avg tier
- 100%
- Prior auth required
What the CMS Formulary Data Shows for certolizumab pegol 200 MG Injection [Cimzia]
Per the CMS 2026 Part D formulary file, certolizumab pegol 200 MG Injection [Cimzia] (RxNorm concept RXCUI 795085, generic name certolizumab pegol) appears on 112 distinct formulary files spanning 325 Medicare Part D plan offerings - 6.4% 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 certolizumab pegol 200 MG Injection [Cimzia] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 54.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 5,329 Part D beneficiaries filled certolizumab pegol 200 MG Injection [Cimzia] in 2023, with total plan-and-beneficiary spending of $256,762,427 and an average per-beneficiary annual cost of $48,182.10. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry certolizumab pegol 200 MG Injection [Cimzia] today.
Coverage Details
- Formularies covering
- 112
- Plans covering
- 325
- Coverage rate
- 6.4%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 54.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 5,329
- Total spending
- $256,762,427
- Avg per beneficiary
- $48,182.10
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering certolizumab pegol 200 MG Injection [Cimzia]
100 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 |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | Yes | $0 | AL |
| 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 |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | Yes | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | Yes | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $0 | NY |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $0 | AR |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | Yes | $4.80 | FL |
Show the next 30 plans
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | Yes | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | American Health Plan OF FL, Inc. | T1 | Yes | $4.80 | FL |
| SECUR Advantage (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| SECUR Enhanced (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | Yes | $8.80 | MI |
| Senior Care (HMO I-SNP) | Align Senior Care MI, LLC | T1 | Yes | $8.80 | MI |
| Tribute Select (HMO-POS I-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $8.90 | AR |
| AgeRight Advantage Health Plan (HMO I-SNP) | Marquis Advantage, Inc. | T1 | Yes | $10.50 | OR, WA |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| Senior Care (HMO I-SNP) | Align Senior Care California Inc. | T1 | Yes | $12.00 | CA |
| Liberty Medicare Dual Plan (HMO D-SNP) | Liberty Advantage, LLC | T1 | Yes | $14.70 | NC |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Illinois, Inc. | 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 |
| KeyCare Advantage (HMO I-SNP) | Isnp Ventures, LLC | T1 | Yes | $23.20 | MD |
| American Health Advantage of Mississippi (HMO I-SNP) | American Health Plan OF MS, Inc. | T1 | Yes | $23.80 | MS |
| Senior Care (HMO I-SNP) | Lifeworks Advantage, LLC | T1 | Yes | $24.60 | VA |
| PruittHealth Premier (HMO I-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $25.40 | GA |
| Georgia Health Advantage (HMO I-SNP) | Georgia Assurance, Inc. | T1 | Yes | $25.40 | GA |
| Georgia Health Advantage Choice (HMO I-SNP) | Georgia Assurance, Inc. | T1 | Yes | $25.40 | GA |
| American Health Advantage of Tennessee (HMO I-SNP) | American Health Plan, Inc. | T1 | Yes | $27.70 | TN |
| Simpra Advantage Nursing Home Plan (PPO I-SNP) | Simpra Advantage, Inc. | T1 | Yes | $27.70 | AL |
| American Health Advantage of Oklahoma (HMO I-SNP) | Oklahoma Superior Select, Inc. | T1 | Yes | $28.20 | OK |
| NHC Advantage (HMO I-SNP) | NHC Advantage, LLC | T1 | Yes | $31.00 | MO, NC, SC, TN |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is certolizumab pegol 200 MG Injection [Cimzia] covered by Medicare Part D?
Yes, certolizumab pegol 200 MG Injection [Cimzia] is covered by 325 Medicare Part D plans (6.4% of all Part D formularies).
What tier is certolizumab pegol 200 MG Injection [Cimzia] on Medicare Part D plans?
certolizumab pegol 200 MG Injection [Cimzia] averages Tier 3.7 across Part D plans, ranging from Tier 1 to Tier 5.
Does certolizumab pegol 200 MG Injection [Cimzia] require prior authorization?
100% of Part D formularies require prior authorization for certolizumab pegol 200 MG Injection [Cimzia]. Step therapy: 0%. Quantity limits: 54.5%.
How much does Medicare spend on certolizumab pegol 200 MG Injection [Cimzia]?
In 2023, total Medicare Part D spending on certolizumab pegol 200 MG Injection [Cimzia] was $256,762,427, covering 5,329 beneficiaries. The average spend per beneficiary was $48,182.10.
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
- Soft Gelatin methoxsalen 10 MG Oral Capsule T3.7
- nifurtimox 30 MG Oral Tablet [Lampit] T3.7
- lactulose 20000 MG Powder for Oral Solution [Kristalose] T3.7
- probenecid 500 MG / sulopenem etzadroxil 500 MG Oral Tablet [Orlynvah] T3.7
- {1 (0.1 ML) (diazepam 100 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 10 MG Dose Kit] T3.7
- {2 (0.1 ML) (diazepam 75 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 15 MG Dose Kit] T3.7
Similar prior-authorization rate
- azathioprine 50 MG Oral Tablet 100% PA
- 0.5 ML hepatitis B surface antigen vaccine 0.04 MG/ML Prefilled Syringe [Heplisav-B] 100% PA
- 0.5 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] 100% PA
- 1 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] 100% PA
- sotagliflozin 200 MG Oral Tablet [Inpefa] 100% PA
- mycophenolate mofetil 250 MG Oral Capsule 100% PA