Medicare drug coverage

Actemra: 2027 Medicare Part D coverage

132 of 5,495 Part D plans (2%) list Actemra on their 2027 formulary, the plan's list of covered drugs (down 7 points from 2026). 100% of those require prior authorization, step therapy, or a quantity limit. Plan counts include both Medicare Advantage plans with drug coverage (5,172 MA-PD) and stand-alone drug plans (323 PDP).

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

Data only, not plan advice. Confirm on Medicare.gov Plan Finder or 1-800-MEDICARE.

2027 compared with 2026

Actemra is number 171 by total Medicare Part D spending in 2024 ($236 million). Plans that list it most often put it on tier 5 (a tier is the cost level a plan puts a drug on; a lower tier usually costs less). Counts use 6 RxNorm products for this name.

Actemra Part D coverage, 2026 and 2027
Measure20262027Change
Part D plans in the file5,5185,495-23
Plans that list it523 (9%)132 (2%)-7 points
Prior authorization (of plans that list it)523 (100%)132 (100%)no change
Step therapy (of plans that list it)0 (0%)0 (0%)no change
Quantity limit (of plans that list it)516 (99%)123 (93%)-6 points
Any of the three (of plans that list it)523 (100%)132 (100%)no change
Not listed or restricted (of all plans)5,518 (100%)5,495 (100%)no change

Source: CMS 2027 Part D formulary file (basic drugs and plan information), as of October 8, 2026. Publisher page

Source: CMS 2026 Part D formulary file (basic drugs and plan information), as of September 30, 2026. Publisher page

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Formulary tier

Actemra formulary tier, 2026 and 2027
Tier2026 plans2027 plans
Tier 140 (8%)12 (9%)
Tier 22 (0%)0 (0%)
Tier 5481 (92%)120 (91%)

Source: CMS 2027 Part D formulary file (basic drugs and plan information), as of October 8, 2026. Publisher page

Source: CMS 2026 Part D formulary file (basic drugs and plan information), as of September 30, 2026. Publisher page

Plan by plan, 2026 to 2027

4,380 plan IDs are in both files. 0 of them (0%) added prior authorization, step therapy, or a quantity limit for Actemra, and 255 stopped listing it.

Actemra: plans in both 2026 and 2027
Plan by planPlans
Same plan ID in both years4,380
Listed it in 2026, not in 2027255 (6%)
Listed it in 2027, not in 20261 (0%)
Moved it to a higher tier0 (0%)
Added prior authorization0 (0%)
Added step therapy0 (0%)
Added a quantity limit0 (0%)
Added at least one of the three0 (0%)
Removed at least one of the three0 (0%)
Plan IDs new in 20271,115
2026 plan IDs not in the 2027 file1,138

Source: CMS 2027 Part D formulary file (basic drugs and plan information), as of October 8, 2026. Publisher page

Source: CMS 2026 Part D formulary file (basic drugs and plan information), as of September 30, 2026. Publisher page

By state

In all 51 states, 100% of 2027 Part D plans offered there leave Actemra off the formulary or list it with prior authorization, step therapy, or a quantity limit, so the states are not ranked. They are listed by name.

Actemra by state, 2027
State2027 plansNot listed or restrictedPrior auth or step therapyChange from 2026
Alabama115100%0%no change
Alaska9100%0%no change
Arizona148100%0%no change
Arkansas86100%3%no change
California397100%0%no change
Colorado106100%0%no change
Connecticut54100%0%no change
Delaware43100%7%no change
District of Columbia21100%0%no change
Florida549100%0%no change
Georgia151100%0%no change
Hawaii50100%0%no change
Idaho45100%0%no change
Illinois133100%0%no change
Indiana140100%0%no change
Iowa64100%0%no change
Kansas84100%0%no change
Kentucky123100%0%no change
Louisiana126100%0%no change
Maine52100%0%no change
Maryland49100%0%no change
Massachusetts92100%13%no change
Michigan183100%0%no change
Minnesota63100%0%no change
Mississippi105100%4%no change
Missouri171100%0%no change
Montana27100%0%no change
Nebraska51100%0%no change
Nevada100100%0%no change
New Hampshire25100%0%no change
New Jersey74100%0%no change
New Mexico68100%0%no change
New York215100%5%no change
North Carolina177100%0%no change
North Dakota26100%0%no change
Ohio173100%2%no change
Oklahoma81100%0%no change
Oregon92100%1%no change
Pennsylvania324100%21%no change
Rhode Island29100%0%no change
South Carolina91100%0%no change
South Dakota30100%0%no change
Tennessee157100%0%no change
Texas412100%0%no change
Utah53100%0%no change
Vermont14100%0%no change
Virginia145100%0%no change
Washington114100%0%no change
West Virginia70100%11%no change
Wisconsin97100%0%no change
Wyoming13100%0%no change

Source: CMS CY2027 landscape file (states and parent organizations), as of September 30, 2026. Publisher page

Source: CMS 2027 Part D formulary file (basic drugs and plan information), as of October 8, 2026. Publisher page

By parent organization

164 parent organizations offer 2027 Part D plans. Humana Inc. has the most, 884, and 100% of them leave Actemra off or restrict it.

Actemra coverage by parent organization, 2027
Parent organization2027 plans ↓List itRestrict it (of listing)Not listed or restrictedChange from 2026Plans that added a restriction
Humana Inc.8840%none list it100%no change0
UnitedHealth Group, Inc.8500%none list it100%no change0
Devoted Health, Inc.7280%none list it100%no change0
CVS Health Corporation6330%none list it100%no change0
Elevance Health, Inc.2940%none list it100%no change0
Centene Corporation2680%none list it100%no change0
Health Care Service Corporation2310%none list it100%no change0
Kaiser Foundation Health Plan, Inc.1120%none list it100%no change0
Highmark Health9893%100%100%no change0
SCAN Group850%none list it100%no change0
Alignment Healthcare USA, LLC770%none list it100%no change0
Guidewell Mutual Holding Corporation5531%100%100%no change0
Blue Cross Blue Shield of Michigan Mutual Ins. Co.430%none list it100%no change0
Molina Healthcare, Inc.430%none list it100%no change0
Corewell Health400%none list it100%no change0
Zing Health Consolidator, Inc360%none list it100%no change0
CAPITAL BLUE CROSS350%none list it100%no change0
Medica Holding Company310%none list it100%no change0
UPMC Health System300%none list it100%no change0
Universal Health Services, Inc.290%none list it100%no change0
MHH Healthcare, L.P.260%none list it100%no change0
Independence Health Group, Inc.250%none list it100%no change0
Point32Health, Inc.230%none list it100%no change0
BlueCross BlueShield of Tennessee220%none list it100%no change0
California Physicians' Service220%none list it100%no change0

Source: CMS CY2027 landscape file (states and parent organizations), as of September 30, 2026. Publisher page

Source: CMS 2027 Part D formulary file (basic drugs and plan information), as of October 8, 2026. Publisher page

Near it by Part D spending

About this data

A plan here is one Part D plan as the CMS formulary files list it: contract, plan, and segment. That covers Medicare Advantage plans with drug coverage and stand-alone drug plans. A plan lists a drug when its formulary has a row for any RxNorm product of that name. When it has several, the row with the lowest tier is the one counted, and restricted means that row has prior authorization, step therapy, or a quantity limit.

A plan with no row for the drug counts as not listing it. That can be a product the file codes another way, so read a low count as a lookup result, not a coverage decision. A state counts every plan the CMS landscape file offers there. Parent organizations are named as CMS names them. The drug list is the top 200 by total Part D spending.

Source: CMS 2027 Part D formulary file (basic drugs and plan information), as of October 8, 2026. Publisher page

Source: CMS CY2027 landscape file (states and parent organizations), as of September 30, 2026. Publisher page

Source: CMS Medicare Part D Spending by Drug, 2024 data, as of June 25, 2026. Publisher page

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