Medicare drug coverage

Epclusa: 2027 Medicare Part D coverage

599 of 5,495 Part D plans (11%) list Epclusa on their 2027 formulary, down 48 points from 2026. 84% of those require prior authorization, step therapy, or a quantity limit.

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2027 compared with 2026

Epclusa is number 61 by total Medicare Part D spending in 2024 ($758 million). Plans that list it most often put it on tier 5. Counts use 5 RxNorm products for this name.

Epclusa Part D coverage, 2026 and 2027
Measure20262027Change
Part D plans in the file5,5185,495-23
Plans that list it3,250 (59%)599 (11%)-48 points
Prior authorization (of plans that list it)3,151 (97%)499 (83%)-14 points
Step therapy (of plans that list it)0 (0%)0 (0%)no change
Quantity limit (of plans that list it)1,744 (54%)402 (67%)+13 points
Any of the three (of plans that list it)3,151 (97%)503 (84%)-13 points
Not listed or restricted (of all plans)5,419 (98%)5,399 (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

Epclusa formulary tier, 2026 and 2027
Tier2026 plans2027 plans
Tier 149 (2%)21 (4%)
Tier 21 (0%)0 (0%)
Tier 449 (2%)7 (1%)
Tier 53,151 (97%)571 (95%)

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. 8 of them (0%) added prior authorization, step therapy, or a quantity limit for Epclusa, and 2,160 stopped listing it.

Epclusa: plans in both 2026 and 2027
Plan by planPlans
Same plan id in both years4,380
Listed it in 2026, not in 20272,160 (49%)
Listed it in 2027, not in 202615 (0%)
Moved it to a higher tier3 (0%)
Added prior authorization0 (0%)
Added step therapy0 (0%)
Added a quantity limit8 (0%)
Added at least one of the three8 (0%)
Removed at least one of the three3 (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 Epclusa off the formulary or list it with prior authorization, step therapy, or a quantity limit. Nevada ranks first at 100%, with 16% 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 Epclusa, 2027
RankState2027 plansNot listed or restrictedPrior auth or step therapyChange from 2026
1Nevada100100%16%no change
2Alabama115100%16%no change
3Arizona148100%15%no change
4Oklahoma81100%14%no change
5Arkansas86100%13%no change
6South Carolina91100%12%no change
7Tennessee157100%11%no change
8Mississippi105100%11%no change
9Alaska9100%11%no change
10Texas412100%11%no change
11Pennsylvania324100%10%no change
12New Jersey74100%9%no change
13Delaware43100%9%no change
14New York215100%9%no change
15North Carolina177100%8%no change
16Wisconsin97100%8%no change
17Wyoming13100%8%no change
18Ohio173100%8%no change
19Vermont14100%7%no change
20Illinois133100%6%no change
21Missouri171100%5%no change
22Kentucky123100%5%no change
23Minnesota63100%5%no change
24New Mexico68100%4%no change
25Florida549100%4%no change
26New Hampshire25100%4%no change
27North Dakota26100%4%no change
28Montana27100%4%no change
29Rhode Island29100%3%no change
30South Dakota30100%3%no change
31Indiana140100%3%no change
32Idaho45100%2%no change
33Michigan183100%2%no change
34Nebraska51100%2%no change
35Maine52100%2%no change
36Utah53100%2%no change
37Connecticut54100%2%no change
38Iowa64100%2%no change
39West Virginia70100%1%no change
40Kansas84100%1%no change
41Massachusetts92100%1%no change
42Louisiana126100%1%no change
43Washington11497%14%no change
44Virginia14596%3%no change
45Oregon9296%16%no change
46Georgia15195%13%no change
47Colorado10690%9%+3 points
48Hawaii5088%2%+1 point
49California39788%28%no change
50District of Columbia2186%5%-2 points
51Maryland4980%8%-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 Epclusa off or restrict it.

Epclusa 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 Foundation1100%100%100%no change0
Alameda Alliance for Health1100%100%100%no change0
AllCare Health, Inc.1100%100%100%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 Services1100%100%100%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 AUTHORITY1100%100%100%no change0
INLAND EMPIRE HEALTH PLAN1100%100%100%no change0
Itasca County10%none list it100%no change0
Kern Health Systems (KHS)1100%100%100%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 Authority10%none list it100%no change0
SAN FRANCISCO HEALTH AUTHORITY1100%100%100%no change0
SAN JOAQUIN COUNTY HEALTH COMMISSION1100%100%100%no change0
SANTA BARBARA SAN LUIS OBISPO REGIONAL HEALTH AUTH1100%100%100%no change0
SANTA CLARA COUNTY HEALTH AUTHORITY1100%100%100%no change0
SANTA CRUZ MONTEREY MERCED SAN BENITO MARIPOSA MAN1100%100%100%no change0
Samaritan Health Services, Inc.10%none list it100%no change0
The Schroer Group, Inc.1100%100%100%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

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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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