Medicare Part D coverage · letermovir · RxCUI 2693193
letermovir 120 MG Oral Pellet [Prevymis]
Per the CMS 2026 Part D formulary file, letermovir 120 MG Oral Pellet [Prevymis] is covered by 3,490 Medicare Part D plans (69.1% of enrollable products), averaging Tier 4.3, with prior authorization required on 76.5% of covering formularies.
- 69.1%
- Plan coverage
- 3,490
- Plans covering
- T4.3
- Avg tier
- 76.5%
- Prior auth required
What the CMS Formulary Data Shows for letermovir 120 MG Oral Pellet [Prevymis]
Per the CMS 2026 Part D formulary file, letermovir 120 MG Oral Pellet [Prevymis] (RxNorm concept RXCUI 2693193, generic name letermovir) appears on 136 distinct formulary files spanning 3,490 Medicare Part D plan offerings - 69.1% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.3.
Real-world access to letermovir 120 MG Oral Pellet [Prevymis] depends on utilization management as much as tier placement: 76.5% of covering formularies require prior authorization. 0% require step therapy. 70.6% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 2,391 Part D beneficiaries filled letermovir 120 MG Oral Pellet [Prevymis] in 2023, with total plan-and-beneficiary spending of $73,949,062 and an average per-beneficiary annual cost of $30,928.09. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry letermovir 120 MG Oral Pellet [Prevymis] today.
Coverage Details
- Formularies covering
- 136
- Plans covering
- 3,490
- Coverage rate
- 69.1%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 76.5% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 70.6% of formularies
2023 Medicare Spending
- Beneficiaries
- 2,391
- Total spending
- $73,949,062
- Avg per beneficiary
- $30,928.09
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering letermovir 120 MG Oral Pellet [Prevymis]
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 |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | Yes | $0 | AL |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| 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 |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $0 | MO |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | Yes | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $0 | DE |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | Yes | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | Yes | $0 | MA |
Show the next 30 plans
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | Yes | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | Yes | $0 | MA |
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | Yes | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | American Health Plan OF FL, Inc. | T1 | Yes | $4.80 | FL |
| SECUR Advantage (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| SECUR Enhanced (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | No | $4.80 | TX |
| Senior Care (HMO I-SNP) | Align Senior Care MI, LLC | T1 | Yes | $8.80 | MI |
| AgeRight Advantage Health Plan (HMO I-SNP) | Marquis Advantage, Inc. | T1 | Yes | $10.50 | OR, WA |
| Senior Care (HMO I-SNP) | Align Senior Care California Inc. | T1 | Yes | $12.00 | CA |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $13.10 | PA |
| Liberty Medicare Dual Plan (HMO D-SNP) | Liberty Advantage, LLC | T1 | Yes | $14.70 | NC |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Illinois | T1 | No | $15.20 | IL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | Yes | $17.00 | AZ |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $17.60 | PA |
| KeyCare Advantage (HMO I-SNP) | Isnp Ventures, LLC | T1 | Yes | $23.20 | MD |
| American Health Advantage of Mississippi (HMO I-SNP) | American Health Plan OF MS, Inc. | T1 | Yes | $23.80 | MS |
| Senior Care (HMO I-SNP) | Lifeworks Advantage, LLC | T1 | Yes | $24.60 | VA |
| PruittHealth Premier (HMO I-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $25.40 | GA |
| Georgia Health Advantage (HMO I-SNP) | Georgia Assurance, Inc. | T1 | Yes | $25.40 | GA |
| Georgia Health Advantage Choice (HMO I-SNP) | Georgia Assurance, Inc. | T1 | Yes | $25.40 | GA |
| American Health Advantage of Tennessee (HMO I-SNP) | American Health Plan, Inc. | T1 | Yes | $27.70 | TN |
| Simpra Advantage Nursing Home Plan (PPO I-SNP) | Simpra Advantage, Inc. | T1 | Yes | $27.70 | AL |
| American Health Advantage of Oklahoma (HMO I-SNP) | Oklahoma Superior Select, Inc. | T1 | Yes | $28.20 | OK |
| NHC Advantage (HMO I-SNP) | NHC Advantage, LLC | T1 | Yes | $31.00 | MO, NC, SC, TN |
| Highmark Health Options Duals Select (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $31.20 | DE |
| Perennial Advantage Strive (HMO I-SNP) | Perennial Advantage OF Ohio, Inc. | T1 | Yes | $31.40 | OH |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is letermovir 120 MG Oral Pellet [Prevymis] covered by Medicare Part D?
Yes, letermovir 120 MG Oral Pellet [Prevymis] is covered by 3,490 Medicare Part D plans (69.1% of all Part D formularies).
What tier is letermovir 120 MG Oral Pellet [Prevymis] on Medicare Part D plans?
letermovir 120 MG Oral Pellet [Prevymis] averages Tier 4.3 across Part D plans, ranging from Tier 1 to Tier 5.
Does letermovir 120 MG Oral Pellet [Prevymis] require prior authorization?
76.5% of Part D formularies require prior authorization for letermovir 120 MG Oral Pellet [Prevymis]. Step therapy: 0%. Quantity limits: 70.6%.
How much does Medicare spend on letermovir 120 MG Oral Pellet [Prevymis]?
In 2023, total Medicare Part D spending on letermovir 120 MG Oral Pellet [Prevymis] was $73,949,062, covering 2,391 beneficiaries. The average spend per beneficiary was $30,928.09.
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
- nilotinib 71 MG Oral Tablet [Danziten] T4.3
- betaine 1000 MG Powder for Oral Solution T4.3
- vigabatrin 100 MG/ML Oral Solution [Vigafyde] T4.3
- vigabatrin 500 MG Powder for Oral Solution [Vigadrone] T4.3
- pomalidomide 1 MG Oral Capsule [Pomalyst] T4.3
- 1.7 ML denosumab-bmwo 70 MG/ML Injection [Osenvelt] T4.3
Similar prior-authorization rate
- 1 ML filgrastim-aafi 0.3 MG/ML Injection [Nivestym] 76.6% PA
- 1.6 ML filgrastim-aafi 0.3 MG/ML Injection [Nivestym] 76.6% PA
- 0.5 ML filgrastim-aafi 0.6 MG/ML Prefilled Syringe [Nivestym] 76.7% PA
- 0.5 ML interferon beta-1a 0.06 MG/ML Prefilled Syringe [Avonex] 76.7% PA
- 0.8 ML filgrastim-aafi 0.6 MG/ML Prefilled Syringe [Nivestym] 76.7% PA
- dimethyl fumarate 120 MG Delayed Release Oral Capsule 76.2% PA