Medicare Part D coverage · epoetin alfa · RxCUI 212218
epoetin alfa 20000 UNT/ML Injectable Solution [Epogen]
Per the CMS 2026 Part D formulary file, epoetin alfa 20000 UNT/ML Injectable Solution [Epogen] is covered by 67 Medicare Part D plans (1.3% of enrollable products), averaging Tier 3.6, with prior authorization required on 100% of covering formularies.
- 1.3%
- Plan coverage
- 67
- Plans covering
- T3.6
- Avg tier
- 100%
- Prior auth required
What the CMS Formulary Data Shows for epoetin alfa 20000 UNT/ML Injectable Solution [Epogen]
Per the CMS 2026 Part D formulary file, epoetin alfa 20000 UNT/ML Injectable Solution [Epogen] (RxNorm concept RXCUI 212218, generic name epoetin alfa) appears on 19 distinct formulary files spanning 67 Medicare Part D plan offerings - 1.3% 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 3.6.
Real-world access to epoetin alfa 20000 UNT/ML Injectable Solution [Epogen] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 5.3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 24,380 Part D beneficiaries filled epoetin alfa 20000 UNT/ML Injectable Solution [Epogen] in 2023, with total plan-and-beneficiary spending of $163,098,995 and an average per-beneficiary annual cost of $6,689.87. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry epoetin alfa 20000 UNT/ML Injectable Solution [Epogen] today.
Coverage Details
- Formularies covering
- 19
- Plans covering
- 67
- Coverage rate
- 1.3%
- 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
- 5.3% of formularies
2023 Medicare Spending
- Beneficiaries
- 24,380
- Total spending
- $163,098,995
- Avg per beneficiary
- $6,689.87
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering epoetin alfa 20000 UNT/ML Injectable Solution [Epogen]
67 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 | T2 | Yes | $0 | CA |
| Geisinger Gold Preferred Complete Rx (PPO) | Geisinger Indemnity Insurance Company | T3 | Yes | $0 | PA |
| Geisinger Gold Secure Rx (HMO D-SNP) | Geisinger Health Plan | T3 | Yes | $0 | PA |
| Geisinger Gold Classic 360 Rx (HMO) | Geisinger Health Plan | T3 | Yes | $0 | PA |
| Geisinger Gold Classic Essential Rx (HMO) | Geisinger Health Plan | T3 | Yes | $0 | PA |
| Geisinger Gold Value Rx (HMO) | Geisinger Health Plan | T3 | Yes | $23.00 | PA |
| Geisinger Gold Classic Complete Rx (HMO) | Geisinger Health Plan | T3 | Yes | $48.00 | PA |
| Geisinger Gold Classic Advantage Rx (HMO) | Geisinger Health Plan | T3 | Yes | $99.30 | PA |
| Geisinger Gold Preferred Advantage Rx (PPO) | Geisinger Indemnity Insurance Company | T3 | Yes | $112.00 | PA |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | Selecthealth, Inc. | T4 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | UT |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | NV |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | CO |
| Select Health Medicare Essential (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | CO |
Show the next 30 plans
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | CO |
| Select Health Medicare Flex (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | CO |
| Select Health Medicare Active (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | Selecthealth, Inc. | T4 | Yes | $0 | NV |
| Select Health Medicare Wellness (HMO) | Selecthealth, Inc. | T4 | Yes | $0 | NV |
| HAP Medicare Explore (PPO) | Alliance Health AND Life Insurance Company | T4 | Yes | $0 | MI |
| HAP Medicare Prime (PPO) | Alliance Health AND Life Insurance Company | T4 | Yes | $0 | MI |
| HAP Medicare Connect (HMO) | Health Alliance Plan OF Michigan | T4 | Yes | $0 | MI |
| HAP Medicare Complete Duals (HMO D-SNP) | Health Alliance Plan OF Michigan | T4 | Yes | $0 | MI |
| HAP Medicare Superior (HMO) | Health Alliance Plan OF Michigan | T4 | Yes | $0 | MI |
| Henry Ford Select (HMO) | Health Alliance Plan OF Michigan | T4 | Yes | $0 | MI |
| Troy Medicare (HMO) | Troy Health, Inc. | T4 | Yes | $0 | NC |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Troy Health, Inc. | T4 | Yes | $0 | NC |
| Contra Costa Health Care Plus (HMO D-SNP) | Contra Costa County Medical Service DBA Contra Costa Health | T4 | Yes | $0 | CA |
| Keystone First VIP Choice (HMO D-SNP) | Vista Health Plan, Inc. | T4 | Yes | $0 | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Vista Health Plan, Inc. | T4 | Yes | $0 | PA |
| First Choice VIP Care (HMO D-SNP) | Select Health OF South Carolina, Inc. | T4 | Yes | $0 | SC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T4 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T4 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Amerihealth Caritas Florida, Inc. | T4 | Yes | $0 | FL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Amerihealth Caritas Louisiana, Inc. | T4 | Yes | $0 | LA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Amerihealth Caritas North Carolina, Inc. | T4 | Yes | $0 | NC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Amerihealth Michigan, Inc. | T4 | Yes | $0 | MI |
| Healthy Mississippi Premier Advantage (HMO-POS) | Healthy Mississippi, Inc. | T4 | Yes | $0 | MS |
| HAP Member Assist (PPO) | Alliance Health AND Life Insurance Company | T4 | Yes | $8.80 | MI |
| HAP Medicare Complete Assist (PPO D-SNP) | Alliance Health AND Life Insurance Company | T4 | Yes | $8.80 | MI |
| HAP Medicare Diabetes and Heart (HMO C-SNP) | Health Alliance Plan OF Michigan | T4 | Yes | $8.80 | MI |
| Samaritan Dual Advantage (HMO D-SNP) | Samaritan Health Plans, Inc. | T4 | Yes | $10.50 | OR |
| HAP Senior Plus Henry Ford Tiered Access (HMO) | Health Alliance Plan OF Michigan | T4 | Yes | $11.30 | MI |
Showing top 50 of 67 plans.
Frequently Asked Questions
Is epoetin alfa 20000 UNT/ML Injectable Solution [Epogen] covered by Medicare Part D?
Yes, epoetin alfa 20000 UNT/ML Injectable Solution [Epogen] is covered by 67 Medicare Part D plans (1.3% of all Part D formularies).
What tier is epoetin alfa 20000 UNT/ML Injectable Solution [Epogen] on Medicare Part D plans?
epoetin alfa 20000 UNT/ML Injectable Solution [Epogen] averages Tier 3.6 across Part D plans, ranging from Tier 1 to Tier 5.
Does epoetin alfa 20000 UNT/ML Injectable Solution [Epogen] require prior authorization?
100% of Part D formularies require prior authorization for epoetin alfa 20000 UNT/ML Injectable Solution [Epogen]. Step therapy: 0%. Quantity limits: 5.3%.
How much does Medicare spend on epoetin alfa 20000 UNT/ML Injectable Solution [Epogen]?
In 2023, total Medicare Part D spending on epoetin alfa 20000 UNT/ML Injectable Solution [Epogen] was $163,098,995, covering 24,380 beneficiaries. The average spend per beneficiary was $6,689.87.
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
- toremifene 60 MG Oral Tablet T3.6
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- olanzapine 10 MG Injection [Zyprexa] T3.6
- ceftolozane 1000 MG / tazobactam 500 MG Injection [Zerbaxa] T3.6
- lopinavir 80 MG/ML / ritonavir 20 MG/ML Oral Solution [Kaletra] T3.6
Similar prior-authorization rate
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- 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