ponesimod 20 MG Oral Tablet [Ponvory]
ponesimod
RxCUI: 2532320
What the CMS Formulary Data Shows for ponesimod 20 MG Oral Tablet [Ponvory]
Per the CMS 2026 Part D formulary file, ponesimod 20 MG Oral Tablet [Ponvory] (RxNorm concept RXCUI 2532320, generic name ponesimod) appears on 12 distinct formulary files spanning 16 Medicare Part D plan offerings - 0.3% 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 4.1.
Real-world access to ponesimod 20 MG Oral Tablet [Ponvory] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 58.3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 99 Part D beneficiaries filled ponesimod 20 MG Oral Tablet [Ponvory] in 2023, with total plan-and-beneficiary spending of $8,307,094 and an average per-beneficiary annual cost of $83,910.04. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry ponesimod 20 MG Oral Tablet [Ponvory] today.
Coverage Details
- Formularies covering
- 12
- Plans covering
- 16
- Coverage rate
- 0.3%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 58.3% of formularies
2023 Medicare Spending
- Beneficiaries
- 99
- Total spending
- $8,307,094
- Avg per beneficiary
- $83,910.04
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering ponesimod 20 MG Oral Tablet [Ponvory]
16 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| Troy Medicare (HMO) | TROY HEALTH, INC. | T5 | Yes | $0 | NC |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | TROY HEALTH, INC. | T5 | Yes | $0 | NC |
| Contra Costa Health Care Plus (HMO D-SNP) | CONTRA COSTA COUNTY MEDICAL SERVICE DBA CONTRA COSTA HEALTH | T5 | Yes | $0 | CA |
| Keystone First VIP Choice (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T5 | Yes | $0 | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T5 | Yes | $0 | PA |
| First Choice VIP Care (HMO D-SNP) | SELECT HEALTH OF SOUTH CAROLINA, INC. | T5 | Yes | $0 | SC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T5 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T5 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS FLORIDA INC | T5 | Yes | $0 | FL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS LOUISIANA, INC. | T5 | Yes | $0 | LA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH MICHIGAN, INC. | T5 | Yes | $0 | MI |
Frequently Asked Questions
Is ponesimod 20 MG Oral Tablet [Ponvory] covered by Medicare Part D?
Yes, ponesimod 20 MG Oral Tablet [Ponvory] is covered by 16 Medicare Part D plans (0.3% of all Part D formularies).
What tier is ponesimod 20 MG Oral Tablet [Ponvory] on Medicare Part D plans?
ponesimod 20 MG Oral Tablet [Ponvory] averages Tier 4.1 across Part D plans, ranging from Tier 1 to Tier 5.
Does ponesimod 20 MG Oral Tablet [Ponvory] require prior authorization?
100% of Part D formularies require prior authorization for ponesimod 20 MG Oral Tablet [Ponvory]. Step therapy: 0%. Quantity limits: 58.3%.
How much does Medicare spend on ponesimod 20 MG Oral Tablet [Ponvory]?
In 2023, total Medicare Part D spending on ponesimod 20 MG Oral Tablet [Ponvory] was $8,307,094, covering 99 beneficiaries. The average spend per beneficiary was $83,910.04.
Read our methodology - how this data is sourced, computed, and verified.