Medicare drug coverage
Epclusa: 2027 Medicare Part D coverage
599 of 5,495 Part D plans (11%) list Epclusa on their 2027 formulary, the plan's list of covered drugs (down 48 points from 2026). 84% 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.
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.
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 (a tier is the cost level a plan puts a drug on; a lower tier usually costs less). Counts use 5 RxNorm products for this name.
| Measure | 2026 | 2027 | Change |
|---|---|---|---|
| Part D plans in the file | 5,518 | 5,495 | -23 |
| Plans that list it | 3,250 (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
Every 2027 stand-alone drug plan
Each stand-alone Part D plan (PDP) with Epclusa's 2027 tier and limits. CMS files a PDP once per region, so one plan name can have several plan IDs; the row shows the tier and limits most of them use. Medicare Advantage drug plans are local: pick a state for its plan-by-plan table.
| Plan (PDP) | Plan IDs | 2027 tier | 2027 limits |
|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP) | 39 | Not listed | Not listed |
| AARP Medicare Rx Saver from UHC (PDP) | 34 | Not listed | Not listed |
| Blue Medicare Rx Enhanced (PDP) | 1 | Not listed | Not listed |
| Blue Medicare Rx Standard (PDP) | 1 | Not listed | Not listed |
| Blue MedicareRx Essentials (PDP) | 1 | Not listed | Not listed |
| Blue MedicareRx Plus (PDP) | 1 | Not listed | Not listed |
| Blue MedicareRx Premier (PDP) | 1 | Not listed | Not listed |
| Blue MedicareRx Value (PDP) | 1 | Not listed | Not listed |
| Blue MedicareRx Value Plus (PDP) | 1 | Not listed | Not listed |
| Blue Shield Rx Enhanced (PDP) | 1 | Not listed | Not listed |
| Blue Shield Rx Plus (PDP) | 1 | Not listed | Not listed |
| BlueMedicare Complete Rx (PDP) | 1 | Not listed | Not listed |
| BlueMedicare Premier Rx (PDP) | 2 | Not listed | Not listed |
| BlueMedicare Value Rx (PDP) | 1 | Not listed | Not listed |
| BlueRx Enhanced Plus (PDP) | 1 | Not listed | Not listed |
| BlueRx Essential (PDP) | 1 | Not listed | Not listed |
| HealthSpring Assurance Rx (PDP) | 35 | Tier 5 | PA, QL |
| HealthSpring Extra Rx (PDP) | 2 | Tier 5 | PA, QL |
| HealthSpring Extra RX (PDP) | 3 | Tier 5 | PA, QL |
| Horizon Medicare Blue Rx Enhanced (PDP) | 1 | Not listed | Not listed |
| Horizon Medicare Blue Rx Standard (PDP) | 1 | Not listed | Not listed |
| Humana Basic Rx Plan (PDP) | 34 | Not listed | Not listed |
| Humana Premier Rx Plan (PDP) | 34 | Not listed | Not listed |
| Humana Value Rx Plan (PDP) | 34 | Not listed | Not listed |
| MedicareBlue Rx Standard (PDP) | 1 | Not listed | Not listed |
| Prescription Blue Premium (PDP) | 1 | Not listed | Not listed |
| Prescription Blue Select (PDP) | 1 | Not listed | Not listed |
| SilverScript Choice (PDP) | 20 | Not listed | Not listed |
| Wellcare Classic (PDP) | 34 | Not listed | Not listed |
| Wellcare Value Script (PDP) | 34 | Not listed | Not listed |
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
By dosage form
The 2027 formularies list Epclusa by dosage form. A plan can cover one form and leave off or restrict another, so each form is counted on its own, across all 5,495 plans.
| Dosage form | Plans that list it | Restricted (of listing) | Most common tier |
|---|---|---|---|
| Oral pellet | 599 (11%) | 503 (84%) | Tier 5 |
| Oral tablet | 599 (11%) | 503 (84%) | Tier 5 |
Source: CMS 2027 Part D formulary file (basic drugs and plan information), as of October 8, 2026. Publisher page
Formulary tier
| Tier | 2026 plans | 2027 plans |
|---|---|---|
| Tier 1 | 49 (2%) | 21 (4%) |
| Tier 2 | 1 (<1%) | 0 (0%) |
| Tier 4 | 49 (2%) | 7 (1%) |
| Tier 5 | 3,151 (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 (<1%) added prior authorization, step therapy, or a quantity limit for Epclusa, and 2,160 stopped listing it.
| Plan by plan | Plans |
|---|---|
| Same plan ID in both years | 4,380 |
| Listed it in 2026, not in 2027 | 2,160 (49%) |
| Listed it in 2027, not in 2026 | 15 (<1%) |
| Moved it to a higher tier | 3 (<1%) |
| Added prior authorization | 0 (0%) |
| Added step therapy | 0 (0%) |
| Added a quantity limit | 8 (<1%) |
| Added at least one of the three | 8 (<1%) |
| Removed at least one of the three | 3 (<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 Epclusa off the formulary or list it with prior authorization, step therapy, or a quantity limit. 42 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 |
|---|---|---|---|---|---|
| Tied 1 | Nevada | 100 | 100% | 16% | no change |
| Tied 1 | Alabama | 115 | 100% | 16% | no change |
| 3 | Arizona | 148 | 100% | 15% | no change |
| 4 | Oklahoma | 81 | 100% | 14% | no change |
| 5 | Arkansas | 86 | 100% | 13% | no change |
| 6 | South Carolina | 91 | 100% | 12% | no change |
| Tied 7 | Tennessee | 157 | 100% | 11% | no change |
| Tied 7 | Mississippi | 105 | 100% | 11% | no change |
| Tied 7 | Alaska | 9 | 100% | 11% | no change |
| Tied 7 | Texas | 412 | 100% | 11% | no change |
| 11 | Pennsylvania | 324 | 100% | 10% | no change |
| Tied 12 | New Jersey | 74 | 100% | 9% | no change |
| Tied 12 | Delaware | 43 | 100% | 9% | no change |
| Tied 12 | New York | 215 | 100% | 9% | no change |
| Tied 15 | North Carolina | 177 | 100% | 8% | no change |
| Tied 15 | Wisconsin | 97 | 100% | 8% | no change |
| Tied 15 | Wyoming | 13 | 100% | 8% | no change |
| Tied 15 | Ohio | 173 | 100% | 8% | no change |
| 19 | Vermont | 14 | 100% | 7% | no change |
| 20 | Illinois | 133 | 100% | 6% | no change |
| Tied 21 | Missouri | 171 | 100% | 5% | no change |
| Tied 21 | Kentucky | 123 | 100% | 5% | no change |
| Tied 21 | Minnesota | 63 | 100% | 5% | no change |
| Tied 24 | New Mexico | 68 | 100% | 4% | no change |
| Tied 24 | Florida | 549 | 100% | 4% | no change |
| Tied 24 | New Hampshire | 25 | 100% | 4% | no change |
| Tied 24 | North Dakota | 26 | 100% | 4% | no change |
| Tied 24 | Montana | 27 | 100% | 4% | no change |
| Tied 29 | Rhode Island | 29 | 100% | 3% | no change |
| Tied 29 | South Dakota | 30 | 100% | 3% | no change |
| Tied 29 | Indiana | 140 | 100% | 3% | no change |
| Tied 32 | Idaho | 45 | 100% | 2% | no change |
| Tied 32 | Michigan | 183 | 100% | 2% | no change |
| Tied 32 | Nebraska | 51 | 100% | 2% | no change |
| Tied 32 | Maine | 52 | 100% | 2% | no change |
| Tied 32 | Utah | 53 | 100% | 2% | no change |
| Tied 32 | Connecticut | 54 | 100% | 2% | no change |
| Tied 32 | Iowa | 64 | 100% | 2% | no change |
| Tied 39 | West Virginia | 70 | 100% | 1% | no change |
| Tied 39 | Kansas | 84 | 100% | 1% | no change |
| Tied 39 | Massachusetts | 92 | 100% | 1% | no change |
| Tied 39 | Louisiana | 126 | 100% | 1% | no change |
| 43 | Washington | 114 | 97% | 14% | -1 point |
| 44 | Oregon | 92 | 96% | 16% | no change |
| 45 | Virginia | 145 | 96% | 3% | no change |
| 46 | Georgia | 151 | 95% | 13% | no change |
| 47 | Colorado | 106 | 90% | 9% | +3 points |
| 48 | California | 397 | 88% | 28% | no change |
| 49 | Hawaii | 50 | 88% | 2% | no change |
| 50 | District of Columbia | 21 | 86% | 5% | -2 points |
| 51 | Maryland | 49 | 80% | 8% | -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 Epclusa 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 |
|---|---|---|---|---|---|---|
| CareFirst, Inc. | 5 | 0% | none list it | 100% | no change | 0 |
| General Catalyst Group Management Holdings LP | 5 | 100% | 100% | 100% | new in 2027 | 0 |
| Harris County Hospital District | 5 | 0% | none list it | 100% | no change | 0 |
| Independent Living Systems, LLC | 5 | 0% | none list it | 100% | no change | 0 |
| Mass General Brigham Incorporated | 5 | 0% | none list it | 100% | no change | 0 |
| PacificSource | 5 | 0% | none list it | 100% | no change | 0 |
| SNP Holdings, LLC | 5 | 0% | none list it | 100% | no change | 0 |
| USAble Mutual Insurance Company | 5 | 0% | none list it | 100% | no change | 0 |
| Baystate Health, Inc. | 6 | 0% | none list it | 100% | no change | 0 |
| Blue Cross Blue Shield of Arizona | 6 | 0% | none list it | 100% | no change | 0 |
| Blue Cross Blue Shield of Kansas | 6 | 0% | none list it | 100% | no change | 0 |
| BlueCross BlueShield of South Carolina (BCBSSC) | 6 | 0% | none list it | 100% | no change | 0 |
| CareSource | 6 | 0% | none list it | 100% | no change | 0 |
| Clever Care Health Plan, Inc. | 6 | 0% | none list it | 100% | no change | 0 |
| Eternal Health of Delaware, Inc. | 6 | 0% | none list it | 100% | no change | 0 |
| Hawaii Medical Service Association | 6 | 0% | none list it | 100% | no change | 0 |
| Health First Shared Services, Inc. | 6 | 0% | none list it | 100% | no change | 0 |
| Independent Health Association, Inc. | 6 | 0% | none list it | 100% | no change | 0 |
| LifeBridge Health, Inc. | 6 | 0% | none list it | 100% | no change | 0 |
| The Health Plan of West Virginia, Inc. | 6 | 0% | none list it | 100% | no change | 0 |
| UNICO Services, Inc. | 6 | 0% | none list it | 100% | no change | 0 |
| Verda Healthcare, Inc. | 6 | 100% | 100% | 100% | no change | 0 |
| Allina Health and Aetna Insurance Holding Company | 7 | 0% | none list it | 100% | no change | 0 |
| Baylor Scott & White Health | 7 | 0% | none list it | 100% | no change | 0 |
| Blue Cross and Blue Shield of Massachusetts, Inc. | 7 | 0% | none list it | 100% | no change | 0 |
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