fingolimod 0.5 MG Disintegrating Oral Tablet [Tascenso]
fingolimod
RxCUI: 2626385
What the CMS Formulary Data Shows for fingolimod 0.5 MG Disintegrating Oral Tablet [Tascenso]
Per the CMS 2026 Part D formulary file, fingolimod 0.5 MG Disintegrating Oral Tablet [Tascenso] (RxNorm concept RXCUI 2626385, generic name fingolimod) appears on 15 distinct formulary files spanning 68 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 4.3.
Real-world access to fingolimod 0.5 MG Disintegrating Oral Tablet [Tascenso] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 73.3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 2,875 Part D beneficiaries filled fingolimod 0.5 MG Disintegrating Oral Tablet [Tascenso] in 2023, with total plan-and-beneficiary spending of $109,017,450 and an average per-beneficiary annual cost of $37,919.11. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry fingolimod 0.5 MG Disintegrating Oral Tablet [Tascenso] today.
Coverage Details
- Formularies covering
- 15
- Plans covering
- 68
- 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
- 73.3% of formularies
2023 Medicare Spending
- Beneficiaries
- 2,875
- Total spending
- $109,017,450
- Avg per beneficiary
- $37,919.11
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering fingolimod 0.5 MG Disintegrating Oral Tablet [Tascenso]
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP) | HM HEALTH INSURANCE COMPANY | T5 | Yes | No | $164.80 | - |
| Blue Rx PDP Plus (PDP) | HM HEALTH INSURANCE COMPANY | T5 | Yes | No | $193.20 | - |
Medicare Advantage Plans (MA-PD) Covering fingolimod 0.5 MG Disintegrating Oral Tablet [Tascenso]
66 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 |
| Community Blue Medicare HMO Signature (HMO) | Highmark Western and Northeastern New York Inc. | T5 | Yes | $0 | NY |
| Community Blue Medicare HMO Merit (HMO) | Highmark Western and Northeastern New York Inc. | T5 | Yes | $0 | NY |
| Community Blue Medicare PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Merit (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Distinct (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue Plus PPO Merit (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Merit (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare HMO Signature (HMO) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Security Blue HMO-POS ValueRx (HMO-POS) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare HMO Signature (HMO) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Together Blue Medicare HMO Signature (HMO) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare HMO Distinct (HMO) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Complete Blue HMO Distinct (HMO) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Distinct (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T5 | Yes | $0 | WV |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T5 | Yes | $0 | WV |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T5 | Yes | $0 | WV |
| Complete Blue PPO Merit (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T5 | Yes | $0 | WV |
| Complete Blue PPO Signature (PPO) | HIGHMARK BCBSD INC. | T5 | Yes | $0 | DE |
| 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 |
| Senior Blue 652 (HMO) | Highmark Western and Northeastern New York Inc. | T5 | Yes | $0.40 | NY |
| Complete Blue PPO Distinct (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $1.00 | PA |
| Complete Blue PPO Distinct (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $6.00 | PA |
| Community Blue Medicare HMO Distinct (HMO) | Highmark Western and Northeastern New York Inc. | T5 | Yes | $6.80 | NY |
| Security Blue HMO-POS ValueRx (HMO-POS) | HIGHMARK CHOICE COMPANY | T5 | Yes | $10.00 | PA |
| Complete Blue PPO Distinct (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $11.00 | PA |
| Complete Blue Plus PPO Distinct (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $11.00 | PA |
| Complete Blue PPO Distinct (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T5 | Yes | $29.00 | WV |
| Senior Blue 651 (HMO) | Highmark Western and Northeastern New York Inc. | T5 | Yes | $30.00 | NY |
| Complete Blue PPO Distinct (PPO) | HIGHMARK BCBSD INC. | T5 | Yes | $36.90 | DE |
Frequently Asked Questions
Is fingolimod 0.5 MG Disintegrating Oral Tablet [Tascenso] covered by Medicare Part D?
Yes, fingolimod 0.5 MG Disintegrating Oral Tablet [Tascenso] is covered by 68 Medicare Part D plans (1.3% of all Part D formularies).
What tier is fingolimod 0.5 MG Disintegrating Oral Tablet [Tascenso] on Medicare Part D plans?
fingolimod 0.5 MG Disintegrating Oral Tablet [Tascenso] averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 5.
Does fingolimod 0.5 MG Disintegrating Oral Tablet [Tascenso] require prior authorization?
100% of Part D formularies require prior authorization for fingolimod 0.5 MG Disintegrating Oral Tablet [Tascenso]. Step therapy: 0%. Quantity limits: 73.3%.
How much does Medicare spend on fingolimod 0.5 MG Disintegrating Oral Tablet [Tascenso]?
In 2023, total Medicare Part D spending on fingolimod 0.5 MG Disintegrating Oral Tablet [Tascenso] was $109,017,450, covering 2,875 beneficiaries. The average spend per beneficiary was $37,919.11.
Read our methodology - how this data is sourced, computed, and verified.