Medicare drug coverage

Emgality: 2027 Medicare Part D coverage

5,051 of 5,495 Part D plans (92%) list Emgality on their 2027 formulary, the plan's list of covered drugs (up 14 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

Emgality is number 158 by total Medicare Part D spending in 2024 ($258 million). Plans that list it most often put it on tier 3 (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.

Emgality Part D coverage, 2026 and 2027
Measure20262027Change
Part D plans in the file5,5185,495-23
Plans that list it4,320 (78%)5,051 (92%)+14 points
Prior authorization (of plans that list it)4,278 (99%)5,004 (99%)no change
Step therapy (of plans that list it)0 (0%)0 (0%)no change
Quantity limit (of plans that list it)4,211 (97%)5,023 (99%)+2 points
Any of the three (of plans that list it)4,298 (99%)5,033 (100%)+1 point
Not listed or restricted (of all plans)5,496 (100%)5,477 (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

Emgality formulary tier, 2026 and 2027
Tier2026 plans2027 plans
Tier 1161 (4%)122 (2%)
Tier 252 (1%)313 (6%)
Tier 33,193 (74%)3,713 (74%)
Tier 4914 (21%)903 (18%)

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. 66 of them (2%) added prior authorization, step therapy, or a quantity limit for Emgality, and 9 stopped listing it.

Emgality: plans in both 2026 and 2027
Plan by planPlans
Same plan ID in both years4,380
Listed it in 2026, not in 20279 (0%)
Listed it in 2027, not in 2026521 (12%)
Moved it to a higher tier44 (1%)
Added prior authorization12 (0%)
Added step therapy0 (0%)
Added a quantity limit54 (1%)
Added at least one of the three66 (2%)
Removed at least one of the three12 (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 Emgality off the formulary or list it with prior authorization, step therapy, or a quantity limit. 49 states tie for the highest share, 100%; Michigan ranks last at 93%. 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 Emgality, 2027
RankState2027 plansNot listed or restrictedPrior auth or step therapyChange from 2026
Tied 1Indiana140100%99%no change
Tied 1Louisiana126100%99%no change
Tied 1Kansas84100%99%no change
Tied 4Iowa64100%98%no change
Tied 4Minnesota63100%98%no change
Tied 4Connecticut54100%98%no change
Tied 4Maine52100%98%no change
Tied 4Nebraska51100%98%no change
Tied 4Wisconsin97100%98%no change
Tied 10West Virginia70100%97%no change
Tied 10Kentucky123100%97%no change
Tied 10South Dakota30100%97%no change
Tied 10Rhode Island29100%97%no change
Tied 14Missouri171100%96%no change
Tied 14Pennsylvania324100%96%no change
Tied 14North Dakota26100%96%no change
Tied 14New Hampshire25100%96%no change
Tied 14New Jersey74100%96%no change
Tied 14New Mexico68100%96%no change
20Oregon92100%95%no change
Tied 21Ohio173100%94%no change
Tied 21Illinois133100%94%no change
Tied 21Oklahoma81100%94%no change
Tied 24Vermont14100%93%no change
Tied 24North Carolina177100%93%no change
Tied 26Utah53100%92%no change
Tied 26Massachusetts92100%92%no change
Tied 26Wyoming13100%92%no change
Tied 26Texas412100%92%no change
30Delaware43100%91%no change
Tied 31Virginia145100%90%no change
Tied 31Arkansas86100%90%no change
Tied 33Arizona148100%89%no change
Tied 33Alaska9100%89%no change
Tied 33Montana27100%89%no change
Tied 33Mississippi105100%89%no change
37South Carolina91100%88%no change
38Tennessee157100%87%no change
Tied 39Hawaii50100%86%no change
Tied 39Nevada100100%86%no change
Tied 41Alabama115100%84%no change
Tied 41Washington114100%84%no change
Tied 41California397100%84%no change
44New York215100%82%no change
Tied 45Georgia151100%81%no change
Tied 45District of Columbia21100%81%no change
47Idaho45100%80%no change
48Colorado106100%78%no change
49Maryland49100%71%no change
50Florida54999%92%+1 point
51Michigan18393%93%-1 point

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 Emgality off or restrict it.

Emgality coverage by parent organization, 2027
Parent organization2027 plans ↑List itRestrict it (of listing)Not listed or restrictedChange from 2026Plans that added a restriction
HealthPartners, Inc.7100%100%100%no change0
Johns Hopkins Healthcare LLC7100%100%100%no change0
Network Health, Inc.7100%100%100%no change0
Singh Holdings LLC7100%100%100%no change0
Astiva Health Holdings Incorporated8100%100%100%no change0
Healthfirst, Inc.8100%100%100%no change0
Longevity Health Founders, LLC8100%100%100%no change0
MVP Health Care, Inc.8100%100%100%no change0
Martin's Point Health Care, Inc.8100%100%100%no change0
Triton Health Systems, L.L.C.8100%100%100%no change0
DOCTORS HEALTHCARE PLANS, INC.9100%100%100%no change0
EmblemHealth, Inc.9100%100%100%no change0
Perennial Consortium, LLC9100%100%100%no change0
West Virginia United Health System, Inc.9100%100%100%no change0
Aware Integrated, Inc.10100%100%100%no change0
Gemstone Holdings, Inc.100%none list it100%no change0
Intermountain Health Care, Inc.10100%100%100%no change0
Thomas Jefferson University10100%100%100%no change0
ATRIO Health Plans11100%100%100%no change0
Curana Health Holdings, LLC12100%100%100%no change0
Fallon Community Health Plan, Inc.12100%100%100%no change0
Louisiana Health Service & Indemnity Company12100%100%100%no change0
Cambia Health Solutions, Inc.13100%100%100%no change0
Clover Health Holdings, Inc.13100%100%100%no change0
Henry Ford Health System13100%8%8%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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