Medicare Part D coverage · fingolimod · RxCUI 1012895
fingolimod 0.5 MG Oral Capsule
Per the CMS 2026 Part D formulary file, fingolimod 0.5 MG Oral Capsule is covered by 4,941 Medicare Part D plans (97.8% of enrollable products), averaging Tier 3.8, with prior authorization required on 80.6% of covering formularies.
- 97.8%
- Plan coverage
- 4,941
- Plans covering
- T3.8
- Avg tier
- 80.6%
- Prior auth required
What the CMS Formulary Data Shows for fingolimod 0.5 MG Oral Capsule
Per the CMS 2026 Part D formulary file, fingolimod 0.5 MG Oral Capsule (RxNorm concept RXCUI 1012895, generic name fingolimod) appears on 315 distinct formulary files spanning 4,941 Medicare Part D plan offerings - 97.8% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 3.8.
Real-world access to fingolimod 0.5 MG Oral Capsule depends on utilization management as much as tier placement: 80.6% of covering formularies require prior authorization. 0% require step therapy. 97.1% 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 Oral Capsule in 2023, with total plan-and-beneficiary spending of $108,657,034 and an average per-beneficiary annual cost of $37,793.75. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry fingolimod 0.5 MG Oral Capsule today.
Coverage Details
- Formularies covering
- 315
- Plans covering
- 4,941
- Coverage rate
- 97.8%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 80.6% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 97.1% of formularies
2023 Medicare Spending
- Beneficiaries
- 2,875
- Total spending
- $108,657,034
- Avg per beneficiary
- $37,793.75
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering fingolimod 0.5 MG Oral Capsule
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| 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 |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | Yes | $0 | NY |
| 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 |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
Show the next 30 plans
| 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 | No | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | No | $0 | AL |
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T1 | Yes | $0 | CA |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | Yes | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | Yes | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| 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 |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| 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 |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | Yes | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | Yes | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $0 | MO |
| 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 |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is fingolimod 0.5 MG Oral Capsule covered by Medicare Part D?
Yes, fingolimod 0.5 MG Oral Capsule is covered by 4,941 Medicare Part D plans (97.8% of all Part D formularies).
What tier is fingolimod 0.5 MG Oral Capsule on Medicare Part D plans?
fingolimod 0.5 MG Oral Capsule averages Tier 3.8 across Part D plans, ranging from Tier 1 to Tier 5.
Does fingolimod 0.5 MG Oral Capsule require prior authorization?
80.6% of Part D formularies require prior authorization for fingolimod 0.5 MG Oral Capsule. Step therapy: 0%. Quantity limits: 97.1%.
How much does Medicare spend on fingolimod 0.5 MG Oral Capsule?
In 2023, total Medicare Part D spending on fingolimod 0.5 MG Oral Capsule was $108,657,034, covering 2,875 beneficiaries. The average spend per beneficiary was $37,793.75.
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
- alanine 5.4 MG/ML / arginine 12 MG/ML / aspartate 3.2 MG/ML / cysteine 0.16 MG/ML / glutamate 5 MG/ML / glycine 3.6 MG/ML / histidine 4.8 MG/ML / isoleucine 8.2 MG/ML / leucine 14 MG/ML / lysine 8.2 MG/ML / methionine 3.4 MG/ML / phenylalanine 4.8 MG/ML / proline 6.8 MG/ML / serine 3.8 MG/ML / taurine 0.25 MG/ML / threonine 4.2 MG/ML / tryptophan 2 MG/ML / tyrosine 2.4 MG/ML / valine 7.8 MG/ML Injectable Solution [PremaSol] T3.8
- risperidone 12.5 MG Injection [Risperdal] T3.8
- ledipasvir 90 MG / sofosbuvir 400 MG Oral Tablet T3.8
- 1.7 ML denosumab-bnht 70 MG/ML Injection [Bomyntra] T3.8
- dapsone 0.05 MG/MG Topical Gel T3.8
- 1 ML certolizumab pegol 200 MG/ML Prefilled Syringe [Cimzia] T3.8
Similar prior-authorization rate
- triptorelin 11.25 MG Injection [Trelstar] 80.6% PA
- triptorelin 22.5 MG Injection [Trelstar] 80.6% PA
- cladribine 10 MG Oral Tablet 81% PA
- 1 ML evolocumab 140 MG/ML Prefilled Syringe [Repatha] 80.1% PA
- 1 ML meperidine hydrochloride 50 MG/ML Injection 80% PA
- sofosbuvir 200 MG Oral Tablet [Sovaldi] 80% PA