Medicare Part D coverage · cladribine · RxCUI 2122634
cladribine 10 MG Oral Tablet
Per the CMS 2026 Part D formulary file, cladribine 10 MG Oral Tablet is covered by 59 Medicare Part D plans (1.2% of enrollable products), averaging Tier 4.1, with prior authorization required on 81% of covering formularies.
- 1.2%
- Plan coverage
- 59
- Plans covering
- T4.1
- Avg tier
- 81%
- Prior auth required
What the CMS Formulary Data Shows for cladribine 10 MG Oral Tablet
Per the CMS 2026 Part D formulary file, cladribine 10 MG Oral Tablet (RxNorm concept RXCUI 2122634, generic name cladribine) appears on 21 distinct formulary files spanning 59 Medicare Part D plan offerings - 1.2% 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 4.1.
Real-world access to cladribine 10 MG Oral Tablet depends on utilization management as much as tier placement: 81% of covering formularies require prior authorization. 0% require step therapy. 4.8% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 1,130 Part D beneficiaries filled cladribine 10 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $156,344,544 and an average per-beneficiary annual cost of $138,358.00. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry cladribine 10 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 21
- Plans covering
- 59
- Coverage rate
- 1.2%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 81% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 4.8% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,130
- Total spending
- $156,344,544
- Avg per beneficiary
- $138,358.00
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering cladribine 10 MG Oral Tablet
59 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | Yes | $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 |
| Troy Medicare (HMO) | Troy Health, Inc. | T5 | Yes | $0 | NC |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Troy Health, Inc. | T5 | Yes | $0 | NC |
| Contra Costa Health Care Plus (HMO D-SNP) | Contra Costa County Medical Service DBA Contra Costa Health | T5 | Yes | $0 | CA |
| Keystone First VIP Choice (HMO D-SNP) | Vista Health Plan, Inc. | T5 | Yes | $0 | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Vista Health Plan, Inc. | T5 | Yes | $0 | PA |
| First Choice VIP Care (HMO D-SNP) | Select Health OF South Carolina, Inc. | T5 | Yes | $0 | SC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T5 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T5 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Amerihealth Caritas Florida, Inc. | T5 | Yes | $0 | FL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Amerihealth Caritas Louisiana, Inc. | T5 | Yes | $0 | LA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Amerihealth Caritas North Carolina, Inc. | T5 | Yes | $0 | NC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Amerihealth Michigan, Inc. | T5 | Yes | $0 | MI |
| Prominence Plus (HMO) | Prominence Healthfirst | T5 | Yes | $0 | NV |
| Prominence Plus (HMO) | Prominence Healthfirst | T5 | Yes | $0 | NV |
Show the next 30 plans
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst | T5 | Yes | $0 | NV |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst | T5 | Yes | $0 | NV |
| Prominence Giveback (HMO) | Prominence Healthfirst | T5 | Yes | $0 | NV |
| Prominence Plus (HMO) | Prominence Healthfirst OF Florida Inc | T5 | Yes | $0 | FL |
| Prominence Giveback (HMO) | Prominence Healthfirst OF Florida Inc | T5 | Yes | $0 | FL |
| Prominence Plus (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Plus (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Extra Help (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Beyond (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Giveback (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Giveback (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Beyond (HMO-POS) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Dual (HMO D-SNP) | Prominence Healthfirst OF Florida Inc | T5 | Yes | $0 | FL |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst | T5 | Yes | $0 | NV |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst OF Florida Inc | T5 | Yes | $0 | FL |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Diabetes and Heart Care Plus (HMO C-SNP) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | Prominence Healthfirst OF Texas | T5 | Yes | $0 | TX |
| Mass General Brigham Advantage (PPO) | Mass General Brigham Health Plan, Inc. | T5 | No | $0 | MA |
| PacificSource Medicare Essentials Rx 27 (HMO) | Pacificsource Community Health Plans | T5 | Yes | $0 | OR |
| PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) | Pacificsource Community Health Plans | T5 | Yes | $0 | MT |
| PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) | Pacificsource Community Health Plans | T5 | Yes | $0 | OR |
| PacificSource Medicare MyCare Rx 40 (HMO) | Pacificsource Community Health Plans | T5 | Yes | $0 | OR |
| PacificSource Dual Care (HMO D-SNP) | Pacificsource Community Health Plans | T5 | Yes | $0 | OR |
| Prominence Extra Help (HMO) | Prominence Healthfirst | T5 | Yes | $4.20 | NV |
| Prominence Extra Help (HMO) | Prominence Healthfirst OF Florida Inc | T5 | Yes | $4.80 | FL |
| Prominence Extra Help (HMO) | Prominence Healthfirst OF Texas | T5 | Yes | $4.80 | TX |
| Prominence Extra Help (HMO) | Prominence Healthfirst | T5 | Yes | $9.50 | NV |
Showing top 50 of 59 plans.
Frequently Asked Questions
Is cladribine 10 MG Oral Tablet covered by Medicare Part D?
Yes, cladribine 10 MG Oral Tablet is covered by 59 Medicare Part D plans (1.2% of all Part D formularies).
What tier is cladribine 10 MG Oral Tablet on Medicare Part D plans?
cladribine 10 MG Oral Tablet averages Tier 4.1 across Part D plans, ranging from Tier 1 to Tier 5.
Does cladribine 10 MG Oral Tablet require prior authorization?
81% of Part D formularies require prior authorization for cladribine 10 MG Oral Tablet. Step therapy: 0%. Quantity limits: 4.8%.
How much does Medicare spend on cladribine 10 MG Oral Tablet?
In 2023, total Medicare Part D spending on cladribine 10 MG Oral Tablet was $156,344,544, covering 1,130 beneficiaries. The average spend per beneficiary was $138,358.00.
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
- sodium phenylbutyrate 0.94 MG/MG Oral Powder T4.1
- 1 ML filgrastim-aafi 0.3 MG/ML Injection [Nivestym] T4.1
- 1.6 ML filgrastim-aafi 0.3 MG/ML Injection [Nivestym] T4.1
- 0.2 ML adalimumab-ryvk 100 MG/ML Prefilled Syringe [Simlandi] T4.1
- 0.4 ML adalimumab-ryvk 100 MG/ML Auto-Injector [Simlandi] T4.1
- 0.8 ML adalimumab-ryvk 100 MG/ML Auto-Injector [Simlandi] T4.1
Similar prior-authorization rate
- tazarotene 0.5 MG/ML Topical Cream 81.2% PA
- 1 ML glatiramer acetate 20 MG/ML Prefilled Syringe 81.2% PA
- 1 ML glatiramer acetate 40 MG/ML Prefilled Syringe 81.3% PA
- triptorelin 11.25 MG Injection [Trelstar] 80.6% PA
- triptorelin 22.5 MG Injection [Trelstar] 80.6% PA
- fingolimod 0.5 MG Oral Capsule 80.6% PA