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).

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

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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

Every 2027 stand-alone drug plan

Each stand-alone Part D plan (PDP) with Actemra's 2027 tier and limits. CMS files a PDP once per region, so one plan name can have several plan IDs; the row shows the tier and limits most of them use. Medicare Advantage drug plans are local: pick a state for its plan-by-plan table.

Actemra on every 2027 stand-alone Part D plan
Plan (PDP)Plan IDs2027 tier2027 limits
AARP Medicare Rx Preferred from UHC (PDP)39Not listedNot listed
AARP Medicare Rx Saver from UHC (PDP)34Not listedNot listed
Blue Medicare Rx Enhanced (PDP)1Not listedNot listed
Blue Medicare Rx Standard (PDP)1Not listedNot listed
Blue MedicareRx Essentials (PDP)1Not listedNot listed
Blue MedicareRx Plus (PDP)1Not listedNot listed
Blue MedicareRx Premier (PDP)1Not listedNot listed
Blue MedicareRx Value (PDP)1Not listedNot listed
Blue MedicareRx Value Plus (PDP)1Not listedNot listed
Blue Shield Rx Enhanced (PDP)1Not listedNot listed
Blue Shield Rx Plus (PDP)1Not listedNot listed
BlueMedicare Complete Rx (PDP)1Not listedNot listed
BlueMedicare Premier Rx (PDP)2Not listedNot listed
BlueMedicare Value Rx (PDP)1Not listedNot listed
BlueRx Enhanced Plus (PDP)1Not listedNot listed
BlueRx Essential (PDP)1Not listedNot listed
HealthSpring Assurance Rx (PDP)35Not listedNot listed
HealthSpring Extra Rx (PDP)2Not listedNot listed
HealthSpring Extra RX (PDP)3Not listedNot listed
Horizon Medicare Blue Rx Enhanced (PDP)1Not listedNot listed
Horizon Medicare Blue Rx Standard (PDP)1Not listedNot listed
Humana Basic Rx Plan (PDP)34Not listedNot listed
Humana Premier Rx Plan (PDP)34Not listedNot listed
Humana Value Rx Plan (PDP)34Not listedNot listed
MedicareBlue Rx Standard (PDP)1Not listedNot listed
Prescription Blue Premium (PDP)1Not listedNot listed
Prescription Blue Select (PDP)1Not listedNot listed
SilverScript Choice (PDP)20Not listedNot listed
Wellcare Classic (PDP)34Not listedNot listed
Wellcare Value Script (PDP)34Not listedNot listed

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

By dosage form

The 2027 formularies list Actemra by dosage form. A plan can cover one form and leave off or restrict another, so each form is counted on its own, across all 5,495 plans.

Actemra by dosage form, 2027
Dosage formPlans that list itRestricted (of listing)Most common tier
Auto-injector132 (2%)132 (100%)Tier 5
Injection0 (0%)none list itnone list it
Prefilled syringe132 (2%)132 (100%)Tier 5

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

Formulary tier

Actemra formulary tier, 2026 and 2027
Tier2026 plans2027 plans
Tier 140 (8%)12 (9%)
Tier 22 (<1%)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 (<1%)
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

States from most to least restrictive

Share of 2027 Part D plans offered in each state that leave Actemra off the formulary or list it with prior authorization, step therapy, or a quantity limit. All 51 states are at 100%. States at the same share are ordered by the prior authorization or step therapy share; states equal on both shares share a rank, marked Tied.

States from most to least restrictive for Actemra, 2027
RankState2027 plansNot listed or restrictedPrior auth or step therapyChange from 2026
1Pennsylvania324100%21%no change
2Massachusetts92100%13%no change
3West Virginia70100%11%no change
4Delaware43100%7%no change
5New York215100%5%no change
6Mississippi105100%4%no change
7Arkansas86100%3%no change
8Ohio173100%2%no change
Tied 9Oregon92100%1%no change
Tied 9California397100%<1%no change
Tied 11Alaska9100%0%no change
Tied 11Alabama115100%0%no change
Tied 11Arizona148100%0%no change
Tied 11Colorado106100%0%no change
Tied 11Connecticut54100%0%no change
Tied 11District of Columbia21100%0%no change
Tied 11Florida549100%0%no change
Tied 11Georgia151100%0%no change
Tied 11Hawaii50100%0%no change
Tied 11Iowa64100%0%no change
Tied 11Idaho45100%0%no change
Tied 11Illinois133100%0%no change
Tied 11Indiana140100%0%no change
Tied 11Kansas84100%0%no change
Tied 11Kentucky123100%0%no change
Tied 11Louisiana126100%0%no change
Tied 11Maryland49100%0%no change
Tied 11Maine52100%0%no change
Tied 11Michigan183100%0%no change
Tied 11Minnesota63100%0%no change
Tied 11Missouri171100%0%no change
Tied 11Montana27100%0%no change
Tied 11North Carolina177100%0%no change
Tied 11North Dakota26100%0%no change
Tied 11Nebraska51100%0%no change
Tied 11New Hampshire25100%0%no change
Tied 11New Jersey74100%0%no change
Tied 11New Mexico68100%0%no change
Tied 11Nevada100100%0%no change
Tied 11Oklahoma81100%0%no change
Tied 11Rhode Island29100%0%no change
Tied 11South Carolina91100%0%no change
Tied 11South Dakota30100%0%no change
Tied 11Tennessee157100%0%no change
Tied 11Texas412100%0%no change
Tied 11Utah53100%0%no change
Tied 11Virginia145100%0%no change
Tied 11Vermont14100%0%no change
Tied 11Washington114100%0%no change
Tied 11Wisconsin97100%0%no change
Tied 11Wyoming13100%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
AIDS Healthcare Foundation10%none list it100%no change0
Alameda Alliance for Health10%none list it100%no change0
AllCare Health, Inc.10%none list it100%no change0
AlohaCare10%none list it100%no change0
BCBS MN, MT, NE, ND, WY, Wellmark IA and SD10%none list it100%no change0
CareOregon, Inc.1100%100%100%no change0
Contra Costa Health Services10%none list it100%no change0
DLP Marquette Health Plan, LLC10%none list it100%no change0
Health Plan of San Mateo10%none list it100%no change0
IMPERIAL COUNTY LOCAL HEALTH AUTHORITY10%none list it100%no change0
INLAND EMPIRE HEALTH PLAN10%none list it100%no change0
Itasca County10%none list it100%no change0
Kern Health Systems (KHS)10%none list it100%no change0
Local Initiative Health Authority for LA County10%none list it100%no change0
Muscogee Creek Nation10%none list it100%new in 20270
Orange County Health Authority1100%100%100%no change0
SAN FRANCISCO HEALTH AUTHORITY10%none list it100%no change0
SAN JOAQUIN COUNTY HEALTH COMMISSION10%none list it100%no change0
SANTA BARBARA SAN LUIS OBISPO REGIONAL HEALTH AUTH10%none list it100%no change0
SANTA CLARA COUNTY HEALTH AUTHORITY10%none list it100%no change0
SANTA CRUZ MONTEREY MERCED SAN BENITO MARIPOSA MAN10%none list it100%no change0
Samaritan Health Services, Inc.10%none list it100%no change0
The Schroer Group, Inc.10%none list it100%no change0
Ventura County Medi-Cal Managed Care Commission10%none list it100%no change0
BayCare Health System, Inc.20%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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