methotrexate 25 MG/ML Injectable Solution
methotrexate
RxCUI: 1946772
What the CMS Formulary Data Shows for methotrexate 25 MG/ML Injectable Solution
Per the CMS 2026 Part D formulary file, methotrexate 25 MG/ML Injectable Solution (RxNorm concept RXCUI 1946772, generic name methotrexate) appears on 327 distinct formulary files spanning 5,028 Medicare Part D plan offerings - 99.2% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 1.8.
Real-world access to methotrexate 25 MG/ML Injectable Solution depends on utilization management as much as tier placement: 33.3% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 84 Part D beneficiaries filled methotrexate 25 MG/ML Injectable Solution in 2023, with total plan-and-beneficiary spending of $248,445 and an average per-beneficiary annual cost of $2,957.68. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry methotrexate 25 MG/ML Injectable Solution today.
Coverage Details
- Formularies covering
- 327
- Plans covering
- 5,028
- Coverage rate
- 99.2%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 33.3% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 84
- Total spending
- $248,445
- Avg per beneficiary
- $2,957.68
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering methotrexate 25 MG/ML Injectable Solution
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 |
| HealthSun HealthAdvantage Plan (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun MediMax (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun MediSun Plus (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun MediSun Extra (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun MediSun Full Dual Plus (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| HealthSun MediSun Full Dual Extra (HMO D-SNP) | HEALTHSUN HEALTH PLANS, INC. | T1 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Level (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply More (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Extra (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Extra Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply More Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Complete Platinum (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Extra Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Extra Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Extra Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply More Platinum (HMO) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Complete Platinum (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Level Platinum (HMO C-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
| Simply Integrated (HMO D-SNP) | SIMPLY HEALTHCARE PLANS, INC. | T1 | No | $0 | FL |
Frequently Asked Questions
Is methotrexate 25 MG/ML Injectable Solution covered by Medicare Part D?
Yes, methotrexate 25 MG/ML Injectable Solution is covered by 5,028 Medicare Part D plans (99.2% of all Part D formularies).
What tier is methotrexate 25 MG/ML Injectable Solution on Medicare Part D plans?
methotrexate 25 MG/ML Injectable Solution averages Tier 1.8 across Part D plans, ranging from Tier 1 to Tier 4.
Does methotrexate 25 MG/ML Injectable Solution require prior authorization?
33.3% of Part D formularies require prior authorization for methotrexate 25 MG/ML Injectable Solution. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on methotrexate 25 MG/ML Injectable Solution?
In 2023, total Medicare Part D spending on methotrexate 25 MG/ML Injectable Solution was $248,445, covering 84 beneficiaries. The average spend per beneficiary was $2,957.68.
Read our methodology - how this data is sourced, computed, and verified.