Medicare drug coverage
Caplyta: 2027 Medicare Part D coverage
5,495 of 5,495 Part D plans (100%) list Caplyta on their 2027 formulary, the plan's list of covered drugs (the same share as 2026). 98% 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.
2027 compared with 2026
Caplyta is number 152 by total Medicare Part D spending in 2024 ($268 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 4 RxNorm products for this name.
| Measure | 2026 | 2027 | Change |
|---|---|---|---|
| Part D plans in the file | 5,518 | 5,495 | -23 |
| Plans that list it | 5,517 (100%) | 5,495 (100%) | no change |
| Prior authorization (of plans that list it) | 1,589 (29%) | 1,575 (29%) | no change |
| Step therapy (of plans that list it) | 269 (5%) | 277 (5%) | no change |
| Quantity limit (of plans that list it) | 5,267 (95%) | 5,356 (97%) | +2 points |
| Any of the three (of plans that list it) | 5,417 (98%) | 5,398 (98%) | no change |
| Not listed or restricted (of all plans) | 5,418 (98%) | 5,398 (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
For pharmacies and agencies: check a whole drug list against 2027 formularies.
Upload your patient list or your book of clients and Rivvi checks each drug against the CMS 2027 formulary files, plan by plan, so you see tier changes and new limits before the next refill or open enrollment. Free to start. HIPAA BAA included.
Formulary tier
| Tier | 2026 plans | 2027 plans |
|---|---|---|
| Tier 1 | 163 (3%) | 123 (2%) |
| Tier 2 | 2 (0%) | 1 (0%) |
| Tier 3 | 56 (1%) | 0 (0%) |
| Tier 4 | 1,163 (21%) | 1,068 (19%) |
| Tier 5 | 4,113 (75%) | 4,303 (78%) |
| Tier 6 | 20 (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. 137 of them (3%) added prior authorization, step therapy, or a quantity limit for Caplyta, and 0 stopped listing it.
| Plan by plan | Plans |
|---|---|
| Same plan ID in both years | 4,380 |
| Listed it in 2026, not in 2027 | 0 (0%) |
| Listed it in 2027, not in 2026 | 0 (0%) |
| Moved it to a higher tier | 152 (3%) |
| Added prior authorization | 43 (1%) |
| Added step therapy | 24 (1%) |
| Added a quantity limit | 74 (2%) |
| Added at least one of the three | 137 (3%) |
| Removed at least one of the three | 42 (1%) |
| Plan IDs new in 2027 | 1,115 |
| 2026 plan IDs not in the 2027 file | 1,138 |
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 Caplyta off the formulary or list it with prior authorization, step therapy, or a quantity limit. 41 states tie for the highest share, 100%; Maryland ranks last at 80%. 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.
| Rank | State | 2027 plans | Not listed or restricted | Prior auth or step therapy | Change from 2026 |
|---|---|---|---|---|---|
| 1 | Michigan | 183 | 100% | 65% | no change |
| 2 | Montana | 27 | 100% | 63% | no change |
| 3 | Massachusetts | 92 | 100% | 61% | no change |
| Tied 4 | Pennsylvania | 324 | 100% | 54% | no change |
| Tied 4 | Wyoming | 13 | 100% | 54% | no change |
| 6 | West Virginia | 70 | 100% | 51% | no change |
| 7 | Vermont | 14 | 100% | 50% | no change |
| 8 | Nevada | 100 | 100% | 45% | no change |
| 9 | Oklahoma | 81 | 100% | 43% | no change |
| 10 | South Carolina | 91 | 100% | 40% | no change |
| 11 | Kentucky | 123 | 100% | 37% | no change |
| Tied 12 | New Hampshire | 25 | 100% | 36% | no change |
| Tied 12 | Utah | 53 | 100% | 36% | no change |
| 14 | New Jersey | 74 | 100% | 34% | no change |
| Tied 15 | Alaska | 9 | 100% | 33% | no change |
| Tied 15 | Iowa | 64 | 100% | 33% | no change |
| Tied 15 | North Carolina | 177 | 100% | 33% | no change |
| Tied 15 | Florida | 549 | 100% | 33% | no change |
| Tied 15 | Delaware | 43 | 100% | 33% | no change |
| Tied 15 | Louisiana | 126 | 100% | 33% | no change |
| 21 | Arizona | 148 | 100% | 32% | no change |
| Tied 22 | Maine | 52 | 100% | 29% | no change |
| Tied 22 | Minnesota | 63 | 100% | 29% | no change |
| Tied 24 | Texas | 412 | 100% | 28% | no change |
| Tied 24 | Arkansas | 86 | 100% | 28% | no change |
| Tied 24 | New York | 215 | 100% | 28% | no change |
| Tied 24 | Indiana | 140 | 100% | 28% | no change |
| Tied 28 | North Dakota | 26 | 100% | 27% | no change |
| Tied 28 | Idaho | 45 | 100% | 27% | no change |
| 30 | Missouri | 171 | 100% | 26% | no change |
| Tied 31 | Nebraska | 51 | 100% | 25% | no change |
| Tied 31 | Kansas | 84 | 100% | 25% | no change |
| Tied 31 | New Mexico | 68 | 100% | 25% | no change |
| Tied 31 | Mississippi | 105 | 100% | 25% | no change |
| 35 | Ohio | 173 | 100% | 24% | no change |
| Tied 36 | South Dakota | 30 | 100% | 23% | no change |
| Tied 36 | Illinois | 133 | 100% | 23% | no change |
| 38 | Alabama | 115 | 100% | 20% | no change |
| 39 | Tennessee | 157 | 100% | 17% | no change |
| 40 | Connecticut | 54 | 100% | 13% | no change |
| 41 | Rhode Island | 29 | 100% | 10% | no change |
| 42 | Wisconsin | 97 | 99% | 48% | no change |
| 43 | Washington | 114 | 97% | 32% | -1 point |
| 44 | Oregon | 92 | 96% | 35% | no change |
| 45 | Virginia | 145 | 96% | 34% | no change |
| 46 | Georgia | 151 | 95% | 29% | no change |
| 47 | Colorado | 106 | 90% | 27% | +3 points |
| 48 | California | 397 | 88% | 43% | no change |
| 49 | Hawaii | 50 | 88% | 18% | no change |
| 50 | District of Columbia | 21 | 86% | 19% | -2 points |
| 51 | Maryland | 49 | 80% | 18% | -4 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 Caplyta off or restrict it.
| Parent organization | 2027 plans ↑ | List it | Restrict it (of listing) | Not listed or restricted | Change from 2026 | Plans that added a restriction |
|---|---|---|---|---|---|---|
| AIDS Healthcare Foundation | 1 | 100% | 100% | 100% | no change | 0 |
| Alameda Alliance for Health | 1 | 100% | 100% | 100% | no change | 1 |
| AllCare Health, Inc. | 1 | 100% | 100% | 100% | no change | 0 |
| AlohaCare | 1 | 100% | 100% | 100% | no change | 0 |
| BCBS MN, MT, NE, ND, WY, Wellmark IA and SD | 1 | 100% | 100% | 100% | no change | 0 |
| CareOregon, Inc. | 1 | 100% | 100% | 100% | no change | 0 |
| Contra Costa Health Services | 1 | 100% | 100% | 100% | no change | 1 |
| DLP Marquette Health Plan, LLC | 1 | 100% | 100% | 100% | no change | 0 |
| Health Plan of San Mateo | 1 | 100% | 100% | 100% | no change | 0 |
| IMPERIAL COUNTY LOCAL HEALTH AUTHORITY | 1 | 100% | 100% | 100% | no change | 0 |
| INLAND EMPIRE HEALTH PLAN | 1 | 100% | 100% | 100% | no change | 0 |
| Itasca County | 1 | 100% | 100% | 100% | no change | 0 |
| Kern Health Systems (KHS) | 1 | 100% | 100% | 100% | no change | 0 |
| Local Initiative Health Authority for LA County | 1 | 100% | 100% | 100% | no change | 0 |
| Muscogee Creek Nation | 1 | 100% | 100% | 100% | new in 2027 | 0 |
| Orange County Health Authority | 1 | 100% | 100% | 100% | no change | 0 |
| SAN FRANCISCO HEALTH AUTHORITY | 1 | 100% | 100% | 100% | no change | 0 |
| SAN JOAQUIN COUNTY HEALTH COMMISSION | 1 | 100% | 100% | 100% | no change | 0 |
| SANTA BARBARA SAN LUIS OBISPO REGIONAL HEALTH AUTH | 1 | 100% | 100% | 100% | no change | 0 |
| SANTA CLARA COUNTY HEALTH AUTHORITY | 1 | 100% | 100% | 100% | no change | 0 |
| SANTA CRUZ MONTEREY MERCED SAN BENITO MARIPOSA MAN | 1 | 100% | 100% | 100% | no change | 0 |
| Samaritan Health Services, Inc. | 1 | 100% | 100% | 100% | no change | 0 |
| The Schroer Group, Inc. | 1 | 100% | 100% | 100% | no change | 0 |
| Ventura County Medi-Cal Managed Care Commission | 1 | 100% | 100% | 100% | no change | 0 |
| BayCare Health System, Inc. | 2 | 100% | 100% | 100% | no change | 2 |
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