Data story

94 of the 192 top Medicare drugs lost Part D plans for 2027

Of 192 high-spend Part D drugs tracked in CMS formulary files, 94 were dropped by at least one plan offered in both 2026 and 2027, and 89 were added by at least one. Across all 840,960 drug and plan pairs, plans dropped a drug 40,908 times and added one 20,522 times. Januvia lost the most: 3,211 of 4,380 continuing plans (73%) no longer list it. North Dakota had the highest drop rate, 7% of its drug and plan pairs.

License: a US government work, in the public domain (Public Domain Mark 1.0).

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Quotable summary

Of 192 high-spend Part D drugs tracked in CMS formulary files, 94 were dropped by at least one plan offered in both 2026 and 2027, and 89 were added by at least one. Across all 840,960 drug and plan pairs, plans dropped a drug 40,908 times and added one 20,522 times. Januvia lost the most: 3,211 of 4,380 continuing plans (73%) no longer list it. North Dakota had the highest drop rate, 7% of its drug and plan pairs.

Source: Rivvi analysis of CMS Part D formulary files, October 8, 2026. Link: rivvi.ai/data/part-d-2027-coverage-changes

Drugs dropped by the most continuing plans

Plans offered in both 2026 and 2027 that dropped the drug (dark) or added it (light), CMS formulary files.

Every drug that changed

Plans offered in both years (contract, plan, and segment). Dropped: listed the drug in 2026, not in 2027. Added: the reverse. Restriction: kept the drug and added prior authorization, step therapy, or a quantity limit.
Drug	Plans both years	Dropped	Share dropped	Added	New restriction
Januvia	4,380	3,211	73%	18	102
Stelara	4,380	2,839	65%	6	0
Entresto	4,380	2,554	58%	0	3
Xarelto	4,380	2,315	53%	0	51
Epclusa	4,380	2,160	49%	15	8
Xigduo	4,380	2,098	48%	0	80
Briviact	4,380	2,031	46%	4	0
Humira	4,380	1,386	32%	6	6
Xeljanz	4,380	1,197	27%	2	0
Myrbetriq	4,380	1,114	25%	54	68
Vascepa	4,380	1,097	25%	72	59
teriparatide	4,380	1,069	24%	34	144
Prolia	4,380	1,008	23%	9	54
Lumigan	4,380	933	21%	5	722
Synjardy	4,380	932	21%	330	37
Fiasp	4,380	925	21%	0	31
Camzyos	4,380	899	21%	11	0
Promacta	4,380	871	20%	1	0
Opsumit	4,380	855	20%	3	54
Ubrelvy	4,380	793	18%	16	106
Gattex	4,380	783	18%	13	0
Qulipta	4,380	781	18%	87	31
NovoLog	4,380	774	18%	0	9
Octagam	4,380	641	15%	19	0
Gammaked	4,380	567	13%	12	0
Ingrezza	4,380	557	13%	89	0
Orencia	4,380	449	10%	25	3
Tremfya	4,380	360	8%	95	41
Rytary	4,380	331	8%	0	0
Radicava	4,380	323	7%	729	8
Oxervate	4,380	322	7%	11	0
Uptravi	4,380	280	6%	18	63
Restasis	4,380	275	6%	21	81
Vemlidy	4,380	275	6%	16	14
Actemra	4,380	255	6%	1	0
Rezurock	4,380	242	6%	143	281
Invokana	4,380	240	5%	0	0
Anoro	4,380	226	5%	8	56
Gammaplex	4,380	189	4%	9	0
Gemtesa	4,380	164	4%	19	77
Cimzia	4,380	138	3%	3	3
Oxycontin	4,380	135	3%	0	0
Gammagard	4,380	123	3%	21	0
Brilinta	4,380	123	3%	0	0
Soliqua	4,380	122	3%	20	64
Tresiba	4,380	116	3%	351	0
Advair	4,380	105	2%	6	54
Tasigna	4,380	100	2%	1	0
Toujeo	4,380	96	2%	2	9
Tymlos	4,380	95	2%	28	173
Vyndamax	4,380	89	2%	30	13
Multaq	4,380	86	2%	24	36
fluticasone / salmeterol	4,380	73	2%	0	8
Forteo	4,380	69	2%	0	0
Aristada	4,380	68	2%	6	152
Acthar	4,380	63	1%	1	0
albuterol sulfate	4,380	60	1%	45	0
Skyrizi	4,380	59	1%	20	29
Premarin	4,380	59	1%	19	28
Xiidra	4,380	55	1%	24	86
Creon	4,380	55	1%	0	0
Privigen	4,380	53	1%	33	0
Copaxone	4,380	53	1%	7	54
Fasenra	4,380	52	1%	5	86
Humalog	4,380	50	1%	20	1
Lokelma	4,380	50	1%	5	475
Praluent	4,380	49	1%	27	0
Aimovig	4,380	46	1%	26	70
Xtampza	4,380	38	1%	39	0
Lantus	4,380	37	1%	8	11
Taltz	4,380	32	1%	1	0
Zenpep	4,380	27	1%	133	0
Arnuity	4,380	22	1%	11	62
Kesimpta	4,380	20	0%	58	15
Mounjaro	4,380	18	0%	13	20
Stiolto	4,380	16	0%	29	54
Incruse	4,380	16	0%	18	5
Tyvaso	4,380	16	0%	2	0
Xywav	4,380	16	0%	0	0
Synthroid	4,380	13	0%	45	0
Nurtec	4,380	11	0%	3	103
Emgality	4,380	9	0%	521	66
Orenitram	4,380	9	0%	49	0
Cosentyx	4,380	9	0%	29	5
Trulicity	4,380	8	0%	11	20
Sprycel	4,380	8	0%	1	0
Velphoro	4,380	4	0%	53	0
Takhzyro	4,380	3	0%	2	0
Symbicort	4,380	3	0%	0	0
Nucala	4,380	2	0%	2,138	49
Korlym	4,380	2	0%	1	0
Basaglar	4,380	2	0%	0	0
Repatha	4,380	2	0%	0	75
Victoza	4,380	2	0%	0	0
Wegovy	4,380	0	0%	4,226	0
Ofev	4,380	0	0%	2,846	62
Pomalyst	4,380	0	0%	2,545	85
Otezla	4,380	0	0%	1,895	30
Farxiga	4,380	0	0%	1,829	1,095
Austedo	4,380	0	0%	450	31
Tradjenta	4,380	0	0%	443	102
Janumet	4,380	0	0%	257	783
Breo	4,380	0	0%	121	63
Rinvoq	4,380	0	0%	77	21
Ozempic	4,380	0	0%	42	21
Humulin R	4,380	0	0%	1	12

Drugs added by the most plans

Plans offered in both years that added the drug for 2027, CMS formulary files.

By state

Drug and plan pairs for plans offered in the state in both years, sorted by share dropped.
State	Pairs	Dropped	Share	Added	Most dropped drug
North Dakota	4,224	280	7%	105	Xarelto (17 of 22)
Minnesota	8,256	501	6%	216	Entresto (29 of 43)
South Dakota	3,456	208	6%	89	Januvia (13 of 18)
New Jersey	11,712	673	6%	369	Januvia (45 of 61)
Wyoming	2,304	126	5%	77	Entresto (10 of 12)
Nebraska	6,720	362	5%	180	Januvia (26 of 35)
Montana	4,608	248	5%	131	Entresto (24 of 24)
South Carolina	16,128	866	5%	398	Januvia (67 of 84)
Vermont	2,112	111	5%	60	Xarelto (9 of 11)
North Carolina	27,456	1,438	5%	804	Januvia (113 of 143)
Alaska	1,536	80	5%	49	Xarelto (7 of 8)
Florida	91,392	4,740	5%	2,197	Januvia (381 of 476)
Delaware	7,296	375	5%	202	Xarelto (26 of 38)
Mississippi	16,320	838	5%	404	Januvia (71 of 85)
Georgia	25,536	1,309	5%	630	Januvia (107 of 133)
Alabama	17,280	883	5%	403	Januvia (83 of 90)
Kentucky	17,856	896	5%	412	Januvia (82 of 93)
Illinois	22,080	1,107	5%	549	Januvia (100 of 115)
Iowa	9,024	450	5%	224	Januvia (34 of 47)
Tennessee	21,120	1,053	5%	427	Januvia (100 of 110)
Arkansas	14,016	696	5%	326	Januvia (65 of 73)
Louisiana	17,664	873	5%	449	Januvia (84 of 92)
Kansas	12,864	635	5%	336	Januvia (56 of 67)
Wisconsin	16,320	805	5%	418	Entresto (65 of 85)
Connecticut	6,720	329	5%	153	Januvia (29 of 35)
Arizona	21,696	1,057	5%	465	Januvia (85 of 113)
Maine	7,680	372	5%	186	Januvia (34 of 40)
Missouri	25,344	1,227	5%	598	Januvia (121 of 132)
Pennsylvania	51,456	2,481	5%	1,357	Stelara (200 of 268)
Texas	59,904	2,864	5%	1,402	Januvia (249 of 312)
Rhode Island	5,376	257	5%	134	Entresto (21 of 28)
Oregon	12,864	614	5%	366	Entresto (57 of 67)
Ohio	27,456	1,309	5%	616	Januvia (123 of 143)
Michigan	29,952	1,424	5%	839	Stelara (91 of 156)
Hawaii	7,872	372	5%	210	Januvia (32 of 41)
Oklahoma	13,056	616	5%	338	Januvia (58 of 68)
Indiana	21,504	1,011	5%	468	Januvia (96 of 112)
New Hampshire	3,072	143	5%	84	Xarelto (16 of 16)
Utah	9,216	427	5%	237	Januvia (41 of 48)
Massachusetts	13,440	622	5%	277	Briviact (51 of 70)
New York	28,416	1,308	5%	596	Januvia (100 of 148)
Maryland	8,448	388	5%	291	Entresto (27 of 44)
Virginia	23,616	1,079	5%	542	Januvia (113 of 123)
West Virginia	11,136	506	5%	281	Januvia (46 of 58)
California	63,552	2,875	5%	1,441	Entresto (265 of 331)
Nevada	16,704	753	5%	381	Januvia (56 of 87)
Colorado	14,976	672	4%	394	Januvia (61 of 78)
New Mexico	10,176	452	4%	289	Januvia (45 of 53)
Washington	15,744	694	4%	420	Entresto (68 of 82)
District of Columbia	3,648	158	4%	100	Entresto (16 of 19)
Idaho	6,912	293	4%	162	Entresto (28 of 36)

Method

Drugs: the 192 highest-spend drugs in the CMS Medicare Part D Spending by Drug file that matched formulary rows in both years, normalized with RxNorm.

Plans: each Part D plan (contract, plan, and segment, MA-PD and PDP) that CMS lists in both the 2026 and the 2027 formulary files. Plans that are new for 2027 or that left are not counted as drops or adds.

A plan lists a drug when its formulary has a row for any RxNorm product of the drug. A plan that replaced a brand with only its generic counts as dropping the brand row. A listing is not a coverage decision for one person.

Download the CSV (3,484 drug and state rows)