Medicare Part D coverage · ozanimod · RxCUI 2288412
ozanimod 0.92 MG Oral Capsule [Zeposia]
Per the CMS 2026 Part D formulary file, ozanimod 0.92 MG Oral Capsule [Zeposia] is covered by 206 Medicare Part D plans (4.1% of enrollable products), averaging Tier 3.6, with prior authorization required on 93.3% of covering formularies.
- 4.1%
- Plan coverage
- 206
- Plans covering
- T3.6
- Avg tier
- 93.3%
- Prior auth required
What the CMS Formulary Data Shows for ozanimod 0.92 MG Oral Capsule [Zeposia]
Per the CMS 2026 Part D formulary file, ozanimod 0.92 MG Oral Capsule [Zeposia] (RxNorm concept RXCUI 2288412, generic name ozanimod) appears on 45 distinct formulary files spanning 206 Medicare Part D plan offerings - 4.1% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 3.6.
Real-world access to ozanimod 0.92 MG Oral Capsule [Zeposia] depends on utilization management as much as tier placement: 93.3% of covering formularies require prior authorization. 0% require step therapy. 82.2% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 1,034 Part D beneficiaries filled ozanimod 0.92 MG Oral Capsule [Zeposia] in 2023, with total plan-and-beneficiary spending of $62,945,499 and an average per-beneficiary annual cost of $60,875.72. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry ozanimod 0.92 MG Oral Capsule [Zeposia] today.
Coverage Details
- Formularies covering
- 45
- Plans covering
- 206
- Coverage rate
- 4.1%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 93.3% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 82.2% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,034
- Total spending
- $62,945,499
- Avg per beneficiary
- $60,875.72
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering ozanimod 0.92 MG Oral Capsule [Zeposia]
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 |
| 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 |
| 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 |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | Yes | $0 | MI |
| 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 |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Advance (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Plus (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| 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 |
Show the next 30 plans
| 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 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | Yes | $8.80 | MI |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $13.10 | PA |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Illinois, Inc. | T1 | Yes | $15.20 | IL |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $17.60 | PA |
| WellSense Added Value (HMO) | Boston Medical Center Health Plan, Inc. | T1 | Yes | $21.70 | NH |
| Highmark Health Options Duals Select (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $31.20 | DE |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Colorado, Inc. | T1 | Yes | $35.20 | CO |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF North Carolina, Inc. | T1 | Yes | $36.20 | NC |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | Yes | $40.00 | NJ |
| ElderServe Star (HMO I-SNP) | Elderserve Health, Inc. | T1 | Yes | $58.80 | NY |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF NEW York, Inc. | T1 | Yes | $58.80 | NY |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T2 | Yes | $0 | CA |
| Community Blue Medicare HMO Signature (HMO) | Highmark Western and Northeastern New York Inc. | T5 | Yes | $0 | NY |
| Community Blue Medicare HMO Merit (HMO) | Highmark Western and Northeastern New York Inc. | T5 | Yes | $0 | NY |
| Community Blue Medicare PPO Signature (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Complete Blue PPO Signature (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Complete Blue PPO Signature (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Complete Blue PPO Merit (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Complete Blue PPO Signature (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Complete Blue PPO Distinct (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Complete Blue Plus PPO Merit (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
| Community Blue Medicare PPO Signature (PPO) | Highmark Senior Health Company | T5 | Yes | $0 | PA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is ozanimod 0.92 MG Oral Capsule [Zeposia] covered by Medicare Part D?
Yes, ozanimod 0.92 MG Oral Capsule [Zeposia] is covered by 206 Medicare Part D plans (4.1% of all Part D formularies).
What tier is ozanimod 0.92 MG Oral Capsule [Zeposia] on Medicare Part D plans?
ozanimod 0.92 MG Oral Capsule [Zeposia] averages Tier 3.6 across Part D plans, ranging from Tier 1 to Tier 5.
Does ozanimod 0.92 MG Oral Capsule [Zeposia] require prior authorization?
93.3% of Part D formularies require prior authorization for ozanimod 0.92 MG Oral Capsule [Zeposia]. Step therapy: 0%. Quantity limits: 82.2%.
How much does Medicare spend on ozanimod 0.92 MG Oral Capsule [Zeposia]?
In 2023, total Medicare Part D spending on ozanimod 0.92 MG Oral Capsule [Zeposia] was $62,945,499, covering 1,034 beneficiaries. The average spend per beneficiary was $60,875.72.
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
- {4 (ozanimod 0.23 MG Oral Capsule [Zeposia]) / 3 (ozanimod 0.46 MG Oral Capsule [Zeposia]) } Pack [Zeposia 7-Day Starter Pack] T3.6
- somatropin 6 MG Cartridge [Humatrope] T3.6
- {2 (1.17 ML romosozumab-aqqg 89.7 MG/ML Prefilled Syringe [Evenity]) } Pack [Evenity 210 MG Dose] T3.6
- 1250 MG estradiol 0.001 MG/MG Topical Gel T3.6
- darunavir 800 MG Oral Tablet T3.6
- eslicarbazepine acetate 600 MG Oral Tablet T3.6
Similar prior-authorization rate
- 1 ML tbo-filgrastim 0.3 MG/ML Injection [Granix] 93.3% PA
- betamethasone dipropionate 0.643 MG/ML / calcipotriene 0.05 MG/ML Topical Foam [Enstilar] 93.3% PA
- vonoprazan 10 MG Oral Tablet [Voquezna] 93.3% PA
- 2 ML lanadelumab-flyo 150 MG/ML Injection [Takhzyro] 93.5% PA
- caplacizumab-yhdp 11 MG Injection [Cablivi] 93.1% PA
- tesamorelin 11.6 MG Injection [Egrifta] 93.5% PA