Medicare Part D coverage · siponimod · RxCUI 2121096
siponimod 0.25 MG Oral Tablet [Mayzent]
Per the CMS 2026 Part D formulary file, siponimod 0.25 MG Oral Tablet [Mayzent] is covered by 409 Medicare Part D plans (8.1% of enrollable products), averaging Tier 4, with prior authorization required on 73.3% of covering formularies.
- 8.1%
- Plan coverage
- 409
- Plans covering
- T4
- Avg tier
- 73.3%
- Prior auth required
What the CMS Formulary Data Shows for siponimod 0.25 MG Oral Tablet [Mayzent]
Per the CMS 2026 Part D formulary file, siponimod 0.25 MG Oral Tablet [Mayzent] (RxNorm concept RXCUI 2121096, generic name siponimod) appears on 120 distinct formulary files spanning 409 Medicare Part D plan offerings - 8.1% 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 4.
Real-world access to siponimod 0.25 MG Oral Tablet [Mayzent] depends on utilization management as much as tier placement: 73.3% of covering formularies require prior authorization. 0% require step therapy. 91.7% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 928 Part D beneficiaries filled siponimod 0.25 MG Oral Tablet [Mayzent] in 2023, with total plan-and-beneficiary spending of $79,550,294 and an average per-beneficiary annual cost of $85,722.30. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry siponimod 0.25 MG Oral Tablet [Mayzent] today.
Coverage Details
- Formularies covering
- 120
- Plans covering
- 409
- Coverage rate
- 8.1%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 73.3% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 91.7% of formularies
2023 Medicare Spending
- Beneficiaries
- 928
- Total spending
- $79,550,294
- Avg per beneficiary
- $85,722.30
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering siponimod 0.25 MG Oral Tablet [Mayzent]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | No | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | No | $0 | AL |
| 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 |
| 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 |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | Yes | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | Yes | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $0 | MO |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $0 | KY, TN |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $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 |
Show the next 30 plans
| 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 |
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | No | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | No | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | No | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | American Health Plan OF FL, Inc. | T1 | No | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | Yes | $4.80 | TX |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Senior Care (HMO I-SNP) | Align Senior Care MI, LLC | T1 | No | $8.80 | MI |
| AgeRight Advantage Health Plan (HMO I-SNP) | Marquis Advantage, Inc. | T1 | No | $10.50 | OR, WA |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| Senior Care (HMO I-SNP) | Align Senior Care California Inc. | T1 | No | $12.00 | CA |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $13.10 | PA |
| Liberty Medicare Dual Plan (HMO D-SNP) | Liberty Advantage, LLC | T1 | No | $14.70 | NC |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Illinois | T1 | Yes | $15.20 | IL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | Yes | $17.00 | AZ |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $17.60 | PA |
| KeyCare Advantage (HMO I-SNP) | Isnp Ventures, LLC | T1 | No | $23.20 | MD |
| American Health Advantage of Mississippi (HMO I-SNP) | American Health Plan OF MS, Inc. | T1 | No | $23.80 | MS |
| Senior Care (HMO I-SNP) | Lifeworks Advantage, LLC | T1 | No | $24.60 | VA |
| PruittHealth Premier (HMO I-SNP) | Pruitthealth Premier, Inc. | T1 | No | $25.40 | GA |
| Georgia Health Advantage (HMO I-SNP) | Georgia Assurance, Inc. | T1 | No | $25.40 | GA |
| Georgia Health Advantage Choice (HMO I-SNP) | Georgia Assurance, Inc. | T1 | No | $25.40 | GA |
| American Health Advantage of Tennessee (HMO I-SNP) | American Health Plan, Inc. | T1 | No | $27.70 | TN |
| Simpra Advantage Nursing Home Plan (PPO I-SNP) | Simpra Advantage, Inc. | T1 | No | $27.70 | AL |
| American Health Advantage of Oklahoma (HMO I-SNP) | Oklahoma Superior Select, Inc. | T1 | No | $28.20 | OK |
| NHC Advantage (HMO I-SNP) | NHC Advantage, LLC | T1 | No | $31.00 | MO, NC, SC, TN |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is siponimod 0.25 MG Oral Tablet [Mayzent] covered by Medicare Part D?
Yes, siponimod 0.25 MG Oral Tablet [Mayzent] is covered by 409 Medicare Part D plans (8.1% of all Part D formularies).
What tier is siponimod 0.25 MG Oral Tablet [Mayzent] on Medicare Part D plans?
siponimod 0.25 MG Oral Tablet [Mayzent] averages Tier 4 across Part D plans, ranging from Tier 1 to Tier 5.
Does siponimod 0.25 MG Oral Tablet [Mayzent] require prior authorization?
73.3% of Part D formularies require prior authorization for siponimod 0.25 MG Oral Tablet [Mayzent]. Step therapy: 0%. Quantity limits: 91.7%.
How much does Medicare spend on siponimod 0.25 MG Oral Tablet [Mayzent]?
In 2023, total Medicare Part D spending on siponimod 0.25 MG Oral Tablet [Mayzent] was $79,550,294, covering 928 beneficiaries. The average spend per beneficiary was $85,722.30.
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
Similar prior-authorization rate
- carbinoxamine maleate 4 MG Oral Tablet 73.3% PA
- tretinoin 0.0004 MG/MG Topical Gel 73.3% PA
- 0.5 ML interferon beta-1a 0.044 MG/ML Prefilled Syringe [Rebif] 73.3% PA
- vigabatrin 500 MG Oral Tablet [Vigadrone] 73.2% PA
- calcium chloride 0.23 MEQ/ML / magnesium chloride 0.53 MEQ/ML / potassium chloride 0.1 MEQ/ML / sodium acetate 1.48 MEQ/ML / sodium chloride 0.27 MEQ/ML Injectable Solution 73.4% PA
- {12 (siponimod 0.25 MG Oral Tablet [Mayzent]) } Pack [Mayzent 2 MG Starter Pack] 73.1% PA