Medicare drug coverage

Benlysta: 2027 Medicare Part D coverage

5,495 of 5,495 Part D plans (100%) list Benlysta on their 2027 formulary, the same share as 2026. 98% of those require prior authorization, step therapy, or a quantity limit.

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2027 compared with 2026

Benlysta is number 182 by total Medicare Part D spending in 2024 ($217 million). Plans that list it most often put it on tier 5. Counts use 5 RxNorm products for this name.

Benlysta Part D coverage, 2026 and 2027
Measure20262027Change
Part D plans in the file5,5185,495-23
Plans that list it5,517 (100%)5,495 (100%)no change
Prior authorization (of plans that list it)5,401 (98%)5,382 (98%)no change
Step therapy (of plans that list it)0 (0%)0 (0%)no change
Quantity limit (of plans that list it)2,739 (50%)2,906 (53%)+3 points
Any of the three (of plans that list it)5,401 (98%)5,382 (98%)no change
Not listed or restricted (of all plans)5,402 (98%)5,382 (98%)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

Benlysta formulary tier, 2026 and 2027
Tier2026 plans2027 plans
Tier 1163 (3%)123 (2%)
Tier 22 (0%)1 (0%)
Tier 449 (1%)46 (1%)
Tier 55,283 (96%)5,325 (97%)
Tier 620 (0%)0 (0%)

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. 74 of them (2%) added prior authorization, step therapy, or a quantity limit for Benlysta, and 0 stopped listing it.

Benlysta: plans in both 2026 and 2027
Plan by planPlans
Same plan id in both years4,380
Listed it in 2026, not in 20270 (0%)
Listed it in 2027, not in 20260 (0%)
Moved it to a higher tier43 (1%)
Added prior authorization0 (0%)
Added step therapy0 (0%)
Added a quantity limit74 (2%)
Added at least one of the three74 (2%)
Removed at least one of the three48 (1%)
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 Benlysta off the formulary or list it with prior authorization, step therapy, or a quantity limit. Alaska ranks first at 100%, with 100% of its plans using prior authorization or step therapy; Maryland ranks last at 80%. Ties break on the prior authorization or step therapy share.

States from most to least restrictive for Benlysta, 2027
RankState2027 plansNot listed or restrictedPrior auth or step therapyChange from 2026
1Alaska9100%100%no change
2Alabama115100%100%no change
3Arkansas86100%100%no change
4Arizona148100%100%no change
5Connecticut54100%100%no change
6Delaware43100%100%no change
7Florida549100%100%no change
8Iowa64100%100%no change
9Idaho45100%100%no change
10Illinois133100%100%no change
11Indiana140100%100%no change
12Kansas84100%100%no change
13Kentucky123100%100%no change
14Louisiana126100%100%no change
15Massachusetts92100%100%no change
16Maine52100%100%no change
17Michigan183100%100%no change
18Minnesota63100%100%no change
19Missouri171100%100%no change
20Mississippi105100%100%no change
21Montana27100%100%no change
22North Carolina177100%100%no change
23North Dakota26100%100%no change
24Nebraska51100%100%no change
25New Hampshire25100%100%no change
26New Jersey74100%100%no change
27New Mexico68100%100%no change
28New York215100%100%no change
29Ohio173100%100%no change
30Oklahoma81100%100%no change
31Pennsylvania324100%100%no change
32Rhode Island29100%100%no change
33South Carolina91100%100%no change
34South Dakota30100%100%no change
35Tennessee157100%100%no change
36Texas412100%100%no change
37Utah53100%100%no change
38Vermont14100%100%no change
39Wisconsin97100%100%no change
40West Virginia70100%100%no change
41Wyoming13100%100%no change
42Nevada10097%97%-3 points
43Virginia14596%96%no change
44Oregon9296%96%no change
45Georgia15195%95%no change
46Colorado10690%90%+3 points
47Hawaii5088%88%+1 point
48California39788%88%no change
49Washington11486%86%+1 point
50District of Columbia2186%86%-2 points
51Maryland4980%80%-5 points

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 Benlysta off or restrict it.

Benlysta 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.884100%100%100%no change0
UnitedHealth Group, Inc.850100%100%100%no change0
Devoted Health, Inc.728100%100%100%no change0
CVS Health Corporation633100%100%100%no change0
Elevance Health, Inc.294100%100%100%no change0
Centene Corporation268100%100%100%no change0
Health Care Service Corporation231100%100%100%no change0
Kaiser Foundation Health Plan, Inc.112100%0%0%no change0
Highmark Health98100%100%100%no change0
SCAN Group85100%100%100%no change54
Alignment Healthcare USA, LLC77100%100%100%no change0
Guidewell Mutual Holding Corporation55100%100%100%no change0
Blue Cross Blue Shield of Michigan Mutual Ins. Co.43100%100%100%no change0
Molina Healthcare, Inc.43100%100%100%no change0
Corewell Health40100%100%100%no change0
Zing Health Consolidator, Inc36100%100%100%no change0
CAPITAL BLUE CROSS35100%100%100%no change0
Medica Holding Company31100%100%100%no change0
UPMC Health System30100%100%100%no change0
Universal Health Services, Inc.29100%100%100%no change0
MHH Healthcare, L.P.26100%100%100%no change0
Independence Health Group, Inc.25100%100%100%no change0
Point32Health, Inc.23100%100%100%no change0
BlueCross BlueShield of Tennessee22100%100%100%no change0
California Physicians' Service22100%100%100%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

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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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