Medicare Part D coverage · letermovir · RxCUI 2693189
letermovir 20 MG Oral Pellet [Prevymis]
Per the CMS 2026 Part D formulary file, letermovir 20 MG Oral Pellet [Prevymis] is covered by 3,286 Medicare Part D plans (65% of enrollable products), averaging Tier 4.5, with prior authorization required on 71.2% of covering formularies.
- 65%
- Plan coverage
- 3,286
- Plans covering
- T4.5
- Avg tier
- 71.2%
- Prior auth required
What the CMS Formulary Data Shows for letermovir 20 MG Oral Pellet [Prevymis]
Per the CMS 2026 Part D formulary file, letermovir 20 MG Oral Pellet [Prevymis] (RxNorm concept RXCUI 2693189, generic name letermovir) appears on 104 distinct formulary files spanning 3,286 Medicare Part D plan offerings - 65% 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 4.5.
Real-world access to letermovir 20 MG Oral Pellet [Prevymis] depends on utilization management as much as tier placement: 71.2% of covering formularies require prior authorization. 0% require step therapy. 63.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 2,391 Part D beneficiaries filled letermovir 20 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 20 MG Oral Pellet [Prevymis] today.
Coverage Details
- Formularies covering
- 104
- Plans covering
- 3,286
- Coverage rate
- 65%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 5, Specialty
Restrictions
- Prior authorization required
- 71.2% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 63.5% 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 20 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 |
| 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 |
| 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 |
Show the next 30 plans
| 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 |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $13.10 | PA |
| 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 |
| Highmark Health Options Duals Select (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $31.20 | DE |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $32.70 | PA |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $32.70 | PA |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $36.20 | NC |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $36.20 | NC |
| Provider Partners Indiana Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $38.40 | IN |
| Provider Partners Indiana Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $38.40 | IN |
| Provider Partners Kentucky Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Kentucky | T1 | No | $38.40 | KY |
| Provider Partners Missouri Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $43.00 | MO |
| Provider Partners Missouri Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $43.00 | MO |
| Freedom VIP Care (HMO C-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T4 | Yes | $0 | FL |
| Optimum Diamond Savings (HMO C-SNP) | Optimum Healthcare, Inc. | T4 | Yes | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T4 | Yes | $0 | FL |
| Optimum Diamond (HMO C-SNP) | Optimum Healthcare, Inc. | T4 | Yes | $0 | FL |
| Freedom Medi-Medi Partial (HMO D-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Freedom Medi-Medi Full (HMO D-SNP) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
| Optimum Emerald Partial (HMO D-SNP) | Optimum Healthcare, Inc. | T4 | Yes | $0 | FL |
| Optimum Emerald Full (HMO D-SNP) | Optimum Healthcare, Inc. | T4 | Yes | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | Freedom Health, Inc. | T4 | Yes | $0 | FL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is letermovir 20 MG Oral Pellet [Prevymis] covered by Medicare Part D?
Yes, letermovir 20 MG Oral Pellet [Prevymis] is covered by 3,286 Medicare Part D plans (65% of all Part D formularies).
What tier is letermovir 20 MG Oral Pellet [Prevymis] on Medicare Part D plans?
letermovir 20 MG Oral Pellet [Prevymis] averages Tier 4.5 across Part D plans, ranging from Tier 1 to Tier 5.
Does letermovir 20 MG Oral Pellet [Prevymis] require prior authorization?
71.2% of Part D formularies require prior authorization for letermovir 20 MG Oral Pellet [Prevymis]. Step therapy: 0%. Quantity limits: 63.5%.
How much does Medicare spend on letermovir 20 MG Oral Pellet [Prevymis]?
In 2023, total Medicare Part D spending on letermovir 20 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
- tedizolid phosphate 200 MG Injection [Sivextro] T4.5
- 0.5 ML tbo-filgrastim 0.6 MG/ML Prefilled Syringe [Granix] T4.5
- 0.8 ML tbo-filgrastim 0.6 MG/ML Prefilled Syringe [Granix] T4.5
- risperidone 37.5 MG Injection [Risperdal] T4.5
- efinaconazole 100 MG/ML Topical Solution [Jublia] T4.5
- deflazacort 6 MG Oral Tablet T4.5
Similar prior-authorization rate
- testosterone enanthate 200 MG/ML Injectable Solution 71.3% PA
- 0.5 ML filgrastim 0.6 MG/ML Prefilled Syringe [Neupogen] 71.4% PA
- 0.8 ML filgrastim 0.6 MG/ML Prefilled Syringe [Neupogen] 71.4% PA
- 1 ML filgrastim 0.3 MG/ML Injection [Neupogen] 71.4% PA
- 1.6 ML filgrastim 0.3 MG/ML Injection [Neupogen] 71.4% PA
- 1 ML peginterferon alfa-2a 0.18 MG/ML Injection [Pegasys] 70.9% PA