Medicare drug coverage

Acthar: 2027 Medicare Part D coverage

116 of 5,495 Part D plans (2%) list Acthar on their 2027 formulary, down 1 point from 2026. 100% of those require prior authorization, step therapy, or a quantity limit.

License. US government work, Public Domain Mark 1.0.

2027 compared with 2026

Acthar is number 118 by total Medicare Part D spending in 2024 ($360 million). Plans that list it most often put it on tier 5. Counts use 4 RxNorm products for this name.

Acthar Part D coverage, 2026 and 2027
Measure20262027Change
Part D plans in the file5,5185,495-23
Plans that list it183 (3%)116 (2%)-1 point
Prior authorization (of plans that list it)183 (100%)116 (100%)no change
Step therapy (of plans that list it)0 (0%)0 (0%)no change
Quantity limit (of plans that list it)27 (15%)29 (25%)+10 points
Any of the three (of plans that list it)183 (100%)116 (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

Formulary tier

Acthar formulary tier, 2026 and 2027
Tier2026 plans2027 plans
Tier 12 (1%)0 (0%)
Tier 21 (1%)0 (0%)
Tier 5180 (98%)116 (100%)

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 Acthar, and 63 stopped listing it.

Acthar: plans in both 2026 and 2027
Plan by planPlans
Same plan id in both years4,380
Listed it in 2026, not in 202763 (1%)
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

States from most to least restrictive

Share of 2027 Part D plans offered in each state that leave Acthar off the formulary or list it with prior authorization, step therapy, or a quantity limit. Michigan ranks first at 100%, with 22% of its plans using prior authorization or step therapy; Wyoming ranks last at 100%. Ties break on the prior authorization or step therapy share.

States from most to least restrictive for Acthar, 2027
RankState2027 plansNot listed or restrictedPrior auth or step therapyChange from 2026
1Michigan183100%22%no change
2Nevada100100%10%no change
3New York215100%10%no change
4Texas412100%3%no change
5Maryland49100%2%no change
6Florida549100%1%no change
7Oregon92100%1%no change
8Alaska9100%0%no change
9Alabama115100%0%no change
10Arkansas86100%0%no change
11Arizona148100%0%no change
12California397100%0%no change
13Colorado106100%0%no change
14Connecticut54100%0%no change
15District of Columbia21100%0%no change
16Delaware43100%0%no change
17Georgia151100%0%no change
18Hawaii50100%0%no change
19Iowa64100%0%no change
20Idaho45100%0%no change
21Illinois133100%0%no change
22Indiana140100%0%no change
23Kansas84100%0%no change
24Kentucky123100%0%no change
25Louisiana126100%0%no change
26Massachusetts92100%0%no change
27Maine52100%0%no change
28Minnesota63100%0%no change
29Missouri171100%0%no change
30Mississippi105100%0%no change
31Montana27100%0%no change
32North Carolina177100%0%no change
33North Dakota26100%0%no change
34Nebraska51100%0%no change
35New Hampshire25100%0%no change
36New Jersey74100%0%no change
37New Mexico68100%0%no change
38Ohio173100%0%no change
39Oklahoma81100%0%no change
40Pennsylvania324100%0%no change
41Rhode Island29100%0%no change
42South Carolina91100%0%no change
43South Dakota30100%0%no change
44Tennessee157100%0%no change
45Utah53100%0%no change
46Virginia145100%0%no change
47Vermont14100%0%no change
48Washington114100%0%no change
49Wisconsin97100%0%no change
50West Virginia70100%0%no change
51Wyoming13100%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 Acthar off or restrict it.

Acthar 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.2948%100%100%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 Health980%none list it100%no change0
SCAN Group850%none list it100%no change0
Alignment Healthcare USA, LLC770%none list it100%no change0
Guidewell Mutual Holding Corporation550%none list it100%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 Health40100%100%100%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.29100%100%100%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

Run it in Rivvi

Which 2027 plans near you dropped or restricted Acthar?

Tier changes and new prior auth, step therapy or quantity limits, plan by plan, before open enrollment.

Free to start. Opens Rivvi, the AI workspace for healthcare teams.

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

Try it on your own data today.

Free to start. Most teams are using it the same day.

Get started for freeSee pricing