Medicare drug coverage

Gammaplex: 2027 Medicare Part D coverage

1,309 of 5,495 Part D plans (24%) list Gammaplex on their 2027 formulary, the same share as 2026. 100% of those require prior authorization, step therapy, or a quantity limit.

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2027 compared with 2026

Gammaplex is number 143 by total Medicare Part D spending in 2024 ($295 million). Plans that list it most often put it on tier 5. Counts use 7 RxNorm products for this name.

Gammaplex Part D coverage, 2026 and 2027
Measure20262027Change
Part D plans in the file5,5185,495-23
Plans that list it1,340 (24%)1,309 (24%)no change
Prior authorization (of plans that list it)1,225 (91%)1,309 (100%)+9 points
Step therapy (of plans that list it)0 (0%)0 (0%)no change
Quantity limit (of plans that list it)0 (0%)0 (0%)no change
Any of the three (of plans that list it)1,225 (91%)1,309 (100%)+9 points
Not listed or restricted (of all plans)5,403 (98%)5,495 (100%)+2 points

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

Gammaplex formulary tier, 2026 and 2027
Tier2026 plans2027 plans
Tier 151 (4%)35 (3%)
Tier 22 (0%)1 (0%)
Tier 310 (1%)8 (1%)
Tier 410 (1%)7 (1%)
Tier 51,247 (93%)1,258 (96%)
Tier 620 (1%)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. 0 of them (0%) added prior authorization, step therapy, or a quantity limit for Gammaplex, and 189 stopped listing it.

Gammaplex: plans in both 2026 and 2027
Plan by planPlans
Same plan id in both years4,380
Listed it in 2026, not in 2027189 (4%)
Listed it in 2027, not in 20269 (0%)
Moved it to a higher tier4 (0%)
Added prior authorization0 (0%)
Added step therapy0 (0%)
Added a quantity limit0 (0%)
Added at least one of the three0 (0%)
Removed at least one of the three0 (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 Gammaplex off the formulary or list it with prior authorization, step therapy, or a quantity limit. Massachusetts ranks first at 100%, with 52% of its plans using prior authorization or step therapy; Wyoming ranks last at 100%. Ties break on the prior authorization or step therapy share.

States from most to least restrictive for Gammaplex, 2027
RankState2027 plansNot listed or restrictedPrior auth or step therapyChange from 2026
1Massachusetts92100%52%no change
2Alabama115100%50%no change
3Hawaii50100%48%+13 points
4Maryland49100%41%+16 points
5Tennessee157100%39%no change
6Arizona148100%33%no change
7Colorado106100%31%+13 points
8Oregon92100%30%+4 points
9Arkansas86100%30%no change
10Mississippi105100%30%no change
11Illinois133100%29%no change
12Florida549100%28%no change
13Ohio173100%27%no change
14North Carolina177100%27%no change
15Connecticut54100%26%no change
16New York215100%25%no change
17Texas412100%25%no change
18New Hampshire25100%24%no change
19Georgia151100%23%+5 points
20Indiana140100%23%no change
21Washington114100%23%+15 points
22Pennsylvania324100%23%no change
23South Carolina91100%22%no change
24Missouri171100%21%no change
25Utah53100%21%no change
26Nebraska51100%20%no change
27New Mexico68100%19%no change
28Delaware43100%19%no change
29Oklahoma81100%19%no change
30Louisiana126100%18%no change
31Iowa64100%17%no change
32Maine52100%15%no change
33Nevada100100%15%no change
34Michigan183100%15%no change
35Vermont14100%14%no change
36Rhode Island29100%14%no change
37Virginia145100%14%+4 points
38New Jersey74100%14%no change
39Kansas84100%13%no change
40Kentucky123100%13%no change
41Idaho45100%7%no change
42Wisconsin97100%5%no change
43District of Columbia21100%5%+12 points
44California397100%4%+12 points
45Minnesota63100%2%no change
46Alaska9100%0%no change
47Montana27100%0%no change
48North Dakota26100%0%no change
49South Dakota30100%0%no change
50West Virginia70100%0%no change
51Wyoming13100%0%no change

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 Gammaplex off or restrict it.

Gammaplex 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.8840%none list it100%no change0
UnitedHealth Group, Inc.8500%none list it100%no change0
Devoted Health, Inc.728100%100%100%no change0
CVS Health Corporation6330%none list it100%no change0
Elevance Health, Inc.2945%100%100%no change0
Centene Corporation2680%none list it100%no change0
Health Care Service Corporation23181%100%100%no change0
Kaiser Foundation Health Plan, Inc.1120%none list it100%+100 points0
Highmark Health980%none list it100%no change0
SCAN Group850%none list it100%no change0
Alignment Healthcare USA, LLC770%none list it100%no change0
Guidewell Mutual Holding Corporation5531%100%100%no change0
Blue Cross Blue Shield of Michigan Mutual Ins. Co.430%none list it100%no change0
Molina Healthcare, Inc.43100%100%100%no change0
Corewell Health400%none list it100%no change0
Zing Health Consolidator, Inc36100%100%100%no change0
CAPITAL BLUE CROSS350%none list it100%no change0
Medica Holding Company310%none list it100%no change0
UPMC Health System300%none list it100%no change0
Universal Health Services, Inc.29100%100%100%no change0
MHH Healthcare, L.P.2677%100%100%no change0
Independence Health Group, Inc.2524%100%100%no change0
Point32Health, Inc.23100%100%100%no change0
BlueCross BlueShield of Tennessee220%none list it100%no change0
California Physicians' Service220%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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