Medicare Part D coverage · dimethyl fumarate · RxCUI 1373489
dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]
Per the CMS 2026 Part D formulary file, dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera] is covered by 17 Medicare Part D plans (0.3% of enrollable products), averaging Tier 3.7, with prior authorization required on 33.3% of covering formularies.
- 0.3%
- Plan coverage
- 17
- Plans covering
- T3.7
- Avg tier
- 33.3%
- Prior auth required
What the CMS Formulary Data Shows for dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]
Per the CMS 2026 Part D formulary file, dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera] (RxNorm concept RXCUI 1373489, generic name dimethyl fumarate) appears on 3 distinct formulary files spanning 17 Medicare Part D plan offerings - 0.3% 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 3.7.
Real-world access to dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera] depends on utilization management as much as tier placement: 33.3% of covering formularies require prior authorization. 0% require step therapy. 100% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 7,901 Part D beneficiaries filled dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera] in 2023, with total plan-and-beneficiary spending of $104,119,392 and an average per-beneficiary annual cost of $13,178.00. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera] today.
Coverage Details
- Formularies covering
- 3
- Plans covering
- 17
- Coverage rate
- 0.3%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 33.3% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 100% of formularies
2023 Medicare Spending
- Beneficiaries
- 7,901
- Total spending
- $104,119,392
- Avg per beneficiary
- $13,178.00
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]
17 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| Hamaspik Medicare Select (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $34.50 | NY |
| Personal Choice 65 Achieve Rx (PPO) | QCC Insurance Company | T5 | No | $0 | PA |
| Keystone 65 Focus Rx (HMO-POS) | Keystone Health Plan East, Inc. | T5 | No | $0 | PA |
| Keystone 65 Focus Rx (HMO-POS) | Keystone Health Plan East, Inc. | T5 | No | $0 | PA |
| Keystone 65 Basic Rx (HMO) | Keystone Health Plan East, Inc. | T5 | No | $0 | PA |
| AmeriHealth Medicare Core (PPO) | Amerihealth Insurance Company OF NEW Jersey | T5 | No | $0 | NJ |
| AmeriHealth Medicare Ultimate (PPO) | Amerihealth Insurance Company OF NEW Jersey | T5 | No | $0 | NJ |
| Keystone 65 Essential Rx (HMO-POS) | Keystone Health Plan East, Inc. | T5 | No | $31.00 | PA |
| AmeriHealth Medicare Enhanced (PPO) | Amerihealth Insurance Company OF NEW Jersey | T5 | No | $36.00 | NJ |
| Keystone 65 Select Rx (HMO) | Keystone Health Plan East, Inc. | T5 | No | $47.00 | PA |
| Keystone 65 Preferred Rx (HMO) | Keystone Health Plan East, Inc. | T5 | No | $59.70 | PA |
| Keystone 65 Select Rx (HMO) | Keystone Health Plan East, Inc. | T5 | No | $63.50 | PA |
| Keystone 65 Preferred Rx (HMO) | Keystone Health Plan East, Inc. | T5 | No | $79.70 | PA |
| Personal Choice 65 Plus Rx (PPO) | QCC Insurance Company | T5 | No | $81.20 | PA |
| Personal Choice 65 Rx (PPO) | QCC Insurance Company | T5 | No | $102.20 | PA |
| Personal Choice 65 Rx (PPO) | QCC Insurance Company | T5 | No | $112.70 | PA |
Frequently Asked Questions
Is dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera] covered by Medicare Part D?
Yes, dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera] is covered by 17 Medicare Part D plans (0.3% of all Part D formularies).
What tier is dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera] on Medicare Part D plans?
dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera] averages Tier 3.7 across Part D plans, ranging from Tier 1 to Tier 5.
Does dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera] require prior authorization?
33.3% of Part D formularies require prior authorization for dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]. Step therapy: 0%. Quantity limits: 100%.
How much does Medicare spend on dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera]?
In 2023, total Medicare Part D spending on dimethyl fumarate 120 MG Delayed Release Oral Capsule [Tecfidera] was $104,119,392, covering 7,901 beneficiaries. The average spend per beneficiary was $13,178.00.
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
- Modified 24 HR metformin hydrochloride 500 MG Extended Release Oral Tablet T3.7
- ergotamine tartrate 2 MG Sublingual Tablet [Ergomar] T3.7
- sildenafil 10 MG/ML Oral Suspension T3.7
- somatropin 12 MG Cartridge [Humatrope] T3.7
- baclofen 5 MG/ML Oral Suspension T3.7
- nitrofurantoin 10 MG/ML Oral Suspension T3.7
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