Medicare Part D coverage · rilonacept · RxCUI 763457
rilonacept 220 MG Injection [Arcalyst]
Per the CMS 2026 Part D formulary file, rilonacept 220 MG Injection [Arcalyst] is covered by 4,870 Medicare Part D plans (96.4% of enrollable products), averaging Tier 4.2, with prior authorization required on 97.3% of covering formularies.
- 96.4%
- Plan coverage
- 4,870
- Plans covering
- T4.2
- Avg tier
- 97.3%
- Prior auth required
What the CMS Formulary Data Shows for rilonacept 220 MG Injection [Arcalyst]
Per the CMS 2026 Part D formulary file, rilonacept 220 MG Injection [Arcalyst] (RxNorm concept RXCUI 763457, generic name rilonacept) appears on 301 distinct formulary files spanning 4,870 Medicare Part D plan offerings - 96.4% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 4.2.
Real-world access to rilonacept 220 MG Injection [Arcalyst] depends on utilization management as much as tier placement: 97.3% of covering formularies require prior authorization. 0% require step therapy. 15% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 173 Part D beneficiaries filled rilonacept 220 MG Injection [Arcalyst] in 2023, with total plan-and-beneficiary spending of $24,779,791 and an average per-beneficiary annual cost of $143,235.79. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry rilonacept 220 MG Injection [Arcalyst] today.
Coverage Details
- Formularies covering
- 301
- Plans covering
- 4,870
- Coverage rate
- 96.4%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 97.3% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 15% of formularies
2023 Medicare Spending
- Beneficiaries
- 173
- Total spending
- $24,779,791
- Avg per beneficiary
- $143,235.79
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering rilonacept 220 MG Injection [Arcalyst]
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 |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | Yes | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | Yes | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| 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 |
| 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 |
| 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 |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is rilonacept 220 MG Injection [Arcalyst] covered by Medicare Part D?
Yes, rilonacept 220 MG Injection [Arcalyst] is covered by 4,870 Medicare Part D plans (96.4% of all Part D formularies).
What tier is rilonacept 220 MG Injection [Arcalyst] on Medicare Part D plans?
rilonacept 220 MG Injection [Arcalyst] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 6.
Does rilonacept 220 MG Injection [Arcalyst] require prior authorization?
97.3% of Part D formularies require prior authorization for rilonacept 220 MG Injection [Arcalyst]. Step therapy: 0%. Quantity limits: 15%.
How much does Medicare spend on rilonacept 220 MG Injection [Arcalyst]?
In 2023, total Medicare Part D spending on rilonacept 220 MG Injection [Arcalyst] was $24,779,791, covering 173 beneficiaries. The average spend per beneficiary was $143,235.79.
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
- 0.5 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Invega] T4.2
- 0.75 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Invega] T4.2
- 1 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Invega] T4.2
- 1.5 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Invega] T4.2
- clobazam 20 MG Oral Film [Sympazan] T4.2
- penicillamine 250 MG Oral Tablet T4.2
Similar prior-authorization rate
- {28 (alpelisib 200 MG Oral Tablet [Vijoice]) / 28 (alpelisib 50 MG Oral Tablet [Vijoice]) } Pack [Vijoice 250 MG 28 Day] 97.3% PA
- glutamine 5000 MG Powder for Oral Solution 97.2% PA
- 0.5 ML ustekinumab-aekn 90 MG/ML Injection [Selarsdi] 97.4% PA
- alanine 21.7 MG/ML / arginine 14.7 MG/ML / aspartate 4.34 MG/ML / glutamate 7.49 MG/ML / glycine 10.4 MG/ML / histidine 8.94 MG/ML / isoleucine 7.49 MG/ML / leucine 10.4 MG/ML / lysine 11.8 MG/ML / methionine 7.49 MG/ML / phenylalanine 10.4 MG/ML / proline 8.94 MG/ML / serine 5.92 MG/ML / threonine 7.49 MG/ML / tryptophan 2.5 MG/ML / tyrosine 0.39 MG/ML / valine 9.6 MG/ML Injectable Solution [Clinisol 15] 97.4% PA
- C1 esterase inhibitor (human) 500 UNT Injection [Berinert] 97.4% PA
- leuprolide acetate 22.5 MG Injection [Lutrate] 97.5% PA