Medicare Part D coverage · pomalidomide · RxCUI 1369730
pomalidomide 3 MG Oral Capsule
Per the CMS 2026 Part D formulary file, pomalidomide 3 MG Oral Capsule is covered by 4,652 Medicare Part D plans (92.1% of enrollable products), averaging Tier 4.1, with prior authorization required on 99.2% of covering formularies.
- 92.1%
- Plan coverage
- 4,652
- Plans covering
- T4.1
- Avg tier
- 99.2%
- Prior auth required
What the CMS Formulary Data Shows for pomalidomide 3 MG Oral Capsule
Per the CMS 2026 Part D formulary file, pomalidomide 3 MG Oral Capsule (RxNorm concept RXCUI 1369730, generic name pomalidomide) appears on 263 distinct formulary files spanning 4,652 Medicare Part D plan offerings - 92.1% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 4.1.
Real-world access to pomalidomide 3 MG Oral Capsule depends on utilization management as much as tier placement: 99.2% of covering formularies require prior authorization. 0% require step therapy. 91.3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 12,739 Part D beneficiaries filled pomalidomide 3 MG Oral Capsule in 2023, with total plan-and-beneficiary spending of $1,709,288,465 and an average per-beneficiary annual cost of $134,177.60. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry pomalidomide 3 MG Oral Capsule today.
Coverage Details
- Formularies covering
- 263
- Plans covering
- 4,652
- Coverage rate
- 92.1%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 99.2% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 91.3% of formularies
2023 Medicare Spending
- Beneficiaries
- 12,739
- Total spending
- $1,709,288,465
- Avg per beneficiary
- $134,177.60
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering pomalidomide 3 MG Oral Capsule
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 |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| 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 |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | Yes | $0 | NY |
| 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 |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
Show the next 30 plans
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | Yes | $0 | MI |
| 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 |
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T1 | Yes | $0 | CA |
| 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 |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | Yes | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | Yes | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $0 | NY |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $0 | AR |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | Yes | $0 | CA |
| 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 |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is pomalidomide 3 MG Oral Capsule covered by Medicare Part D?
Yes, pomalidomide 3 MG Oral Capsule is covered by 4,652 Medicare Part D plans (92.1% of all Part D formularies).
What tier is pomalidomide 3 MG Oral Capsule on Medicare Part D plans?
pomalidomide 3 MG Oral Capsule averages Tier 4.1 across Part D plans, ranging from Tier 1 to Tier 6.
Does pomalidomide 3 MG Oral Capsule require prior authorization?
99.2% of Part D formularies require prior authorization for pomalidomide 3 MG Oral Capsule. Step therapy: 0%. Quantity limits: 91.3%.
How much does Medicare spend on pomalidomide 3 MG Oral Capsule?
In 2023, total Medicare Part D spending on pomalidomide 3 MG Oral Capsule was $1,709,288,465, covering 12,739 beneficiaries. The average spend per beneficiary was $134,177.60.
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
- brivaracetam 10 MG Oral Tablet [Briviact] T4.1
- rifaximin 550 MG Oral Tablet [XIFAXAN] T4.1
- tenofovir disoproxil fumarate 200 MG Oral Tablet [Viread] T4.1
- 1 ML benralizumab 30 MG/ML Prefilled Syringe [Fasenra] T4.1
- deferasirox 250 MG Tablet for Oral Suspension T4.1
- selexipag 1 MG Oral Tablet [Uptravi] T4.1
Similar prior-authorization rate
- levalbuterol 0.103 MG/ML Inhalation Solution 99.2% PA
- levalbuterol 2.5 MG/ML Inhalation Solution 99.2% PA
- epoetin alfa-epbx 10000 UNT/ML Injectable Solution [Retacrit] 99.2% PA
- 1 ML epoetin alfa-epbx 10000 UNT/ML Injection [Retacrit] 99.2% PA
- 1 ML epoetin alfa-epbx 40000 UNT/ML Injection [Retacrit] 99.2% PA
- everolimus 10 MG Oral Tablet [Torpenz] 99.2% PA