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PlainMedicare

Is Tremfya (guselkumab) covered by Medicare Part D?

4,612 of 5,052 Medicare Part D plan offerings (91.3%) list Tremfya on their 2026 formulary, most often on tier 5; 99.3% of the formularies that cover it require prior authorization. Part D spending on it was $619 million in 2024 for at least 10,848 people: what plans and patients paid at the pharmacy, before manufacturer rebates (CMS Part D Spending by Drug).

Plans that cover it
91.3%
4,612 of 5,052 offerings; the median drug: 76%
Usual tier
Tier 5
from tier 1 to tier 5
Prior authorization
99.3%
of formularies that cover it; the median drug: 1%
Quantity limits
77.4%
of formularies that cover it; the median drug: 30%

0.4% of the formularies that cover it require step therapy (trying another drug first).

Source: CMS Part D formulary file, 2026 second quarter: the formularies in use in 2026. A plan's 2027 formulary can differ; check your own plan's coverage in Medicare Plan Finder.

What does it cost under Part D in 2027?

Your yearly cap in 2027
Out-of-pocket spending on covered Part D drugs stops at $2,400 in 2027 ($2,100 in 2026); after that, you pay nothing for covered drugs for the rest of the year.
The deductible
A plan's drug deductible is at most $700 in 2027 ($615 in 2026); many plans charge less or none.

Source: CMS, Announcement of calendar year 2027 Part D parameters; Medicare.gov, “How much does Medicare drug coverage cost?” (read Oct. 7, 2026).

How much does Medicare spend on it?

Part D spending by year

2020$167 million
2021$285 million
2022$439 million
2023$531 million
2024 (latest)$619 million

10,848 people filled it under Part D in 2024, in 46,093 claims. The amounts are what plans and patients paid at the pharmacy, before manufacturer rebates.

Source: CMS Medicare Part D Spending by Drug, 2020 to 2024 (published June 2026). Row used: Tremfya Pen (Guselkumab), Tremfya (Guselkumab).

Which forms and strengths are counted?

  • 1 ml guselkumab 100 mg/ml auto-injector
  • 1 ml guselkumab 100 mg/ml prefilled syringe
  • 2 ml guselkumab 100 mg/ml auto-injector
  • 2 ml guselkumab 100 mg/ml prefilled syringe
  • pack of 2 × 2 ml guselkumab 100 mg/ml auto-injector

What else should you check?

Data, not medical advice. Coverage is the share of plan formularies listing the drug; your plan's formulary, tier and pharmacy decide what you pay.