Medicare drug coverage
Gammaplex in North Carolina: 2027 Part D coverage
48 of 177 Part D plans offered in North Carolina (27%) list Gammaplex on their 2027 formulary, the plan's list of covered drugs (up 3 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 (166 MA-PD) and stand-alone drug plans (11 PDP).
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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.
Every 2027 plan in North Carolina
Each Part D plan offered in North Carolina, with Gammaplex's 2026 and 2027 tier and its 2027 limits. A tier is the cost level a plan puts a drug on; a lower tier usually costs less. Enter a ZIP to see only the plans offered in that county.
PA is prior authorization (the plan must approve it first), ST is step therapy (try another drug first), and QL is a quantity limit. D-SNP, C-SNP, and I-SNP are Special Needs Plans: for people with both Medicare and Medicaid, with certain chronic conditions, or who live in a nursing home or need that level of care. Plans are listed by plan ID.
| Plan | Plan ID | Type | 2026 tier | 2027 tier | 2027 PA / ST / QL | Change |
|---|---|---|---|---|---|---|
| UHC Nursing Home Plan NC-F001 (PPO I-SNP) | H0710-034-000 | MA-PD (PPO I-SNP) | Not listed | Not listed | Not listed | Not listed either year |
| Humana Gold Plus H1036-137 (HMO-POS) | H1036-137-000 | MA-PD (HMO-POS) | Not listed | Not listed | Not listed | Not listed either year |
| Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) | H1036-167-000 | MA-PD (HMO D-SNP) | Not listed | Not listed | Not listed | Not listed either year |
| Humana Gold Plus H1036-233 (HMO-POS) | H1036-233-000 | MA-PD (HMO-POS) | Not listed | Not listed | Not listed | Not listed either year |
| Humana Dual Select H1036-307 (HMO D-SNP) | H1036-307-000 | MA-PD (HMO D-SNP) | Not listed | Not listed | Not listed | Not listed either year |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | H1036-308-000 | MA-PD (HMO C-SNP) | Not listed | Not listed | Not listed | Not listed either year |
| Humana Gold Plus Giveback H1036-318 (HMO-POS) | H1036-318-000 | MA-PD (HMO-POS) | Not listed | Not listed | Not listed | Not listed either year |
| Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) | H1036-331-000 | MA-PD (HMO D-SNP) | Not listed | Not listed | Not listed | Not listed either year |
| Humana Gold Plus H1036-335 (HMO-POS) | H1036-335-001 | MA-PD (HMO-POS) | Not listed | Not listed | Not listed | Not listed either year |
| Humana Gold Plus H1036-335 (HMO-POS) | H1036-335-002 | MA-PD (HMO-POS) | Not listed | Not listed | Not listed | Not listed either year |
| Humana Gold Plus Giveback H1036-343 (HMO-POS) | H1036-343-000 | MA-PD (HMO-POS) | New plan ID | Not listed | Not listed | New plan ID in 2027 |
| UHC Dual Complete NC-Q1 (PPO D-SNP) | H1889-005-000 | MA-PD (PPO D-SNP) | Not listed | Not listed | Not listed | Not listed either year |
| UHC Dual Complete NC-S2 (PPO D-SNP) | H1889-034-000 | MA-PD (PPO D-SNP) | Not listed | Not listed | Not listed | Not listed either year |
| Wellcare Simple Open (PPO) | H1914-007-000 | MA-PD (PPO) | Not listed | Not listed | Not listed | Not listed either year |
| Wellcare Carolina Complete Dual Liberty Open (PPO D-SNP) | H1914-008-000 | MA-PD (PPO D-SNP) | Not listed | Not listed | Not listed | Not listed either year |
| Wellcare Assist Open (PPO) | H1914-009-000 | MA-PD (PPO) | Not listed | Not listed | Not listed | Not listed either year |
| AARP Medicare Advantage from UHC NC-0001 (PPO) | H2001-090-000 | MA-PD (PPO) | Not listed | Not listed | Not listed | Not listed either year |
| AARP Medicare Advantage from UHC NC-0004 (PPO) | H2001-102-000 | MA-PD (PPO) | Not listed | Not listed | Not listed | Not listed either year |
| AARP Medicare Advantage from UHC NC-0016 (PPO) | H2406-034-000 | MA-PD (PPO) | Not listed | Not listed | Not listed | Not listed either year |
| AARP Medicare Advantage from UHC NC-0017 (PPO) | H2406-098-000 | MA-PD (PPO) | Not listed | Not listed | Not listed | Not listed either year |
| AARP Medicare Advantage from UHC NC-0019 (PPO) | H2406-115-000 | MA-PD (PPO) | Not listed | Not listed | Not listed | Not listed either year |
| HealthTeam Advantage Thrive Plan (HMO) | H2624-005-000 | MA-PD (HMO) | New plan ID | Not listed | Not listed | New plan ID in 2027 |
| Aetna Medicare Signature (HMO) | H3146-001-000 | MA-PD (HMO) | Not listed | Not listed | Not listed | Not listed either year |
| Aetna Medicare Full Dual (HMO D-SNP) | H3146-002-000 | MA-PD (HMO D-SNP) | Not listed | Not listed | Not listed | Not listed either year |
| Aetna Medicare Signature (HMO) | H3146-004-000 | MA-PD (HMO) | Not listed | Not listed | Not listed | Not listed either year |
Data only, not plan advice. Confirm on Medicare.gov Plan Finder or 1-800-MEDICARE.
North Carolina compared with the nation
100% of the 177 Part D plans offered in North Carolina leave Gammaplex off the 2027 formulary or restrict it, against 100% nationally (the same). North Carolina is tied with 50 other states at 100% of plans restricting or leaving it off. A plan offered in several states counts in each.
2027 compared with 2026
| Measure | 2026 | 2027 | Change |
|---|---|---|---|
| Part D plans in the file | 173 | 177 | +4 |
| Plans that list it | 41 (24%) | 48 (27%) | +3 points |
| Prior authorization (of plans that list it) | 41 (100%) | 48 (100%) | no change |
| 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) | 41 (100%) | 48 (100%) | no change |
| Not listed or restricted (of all plans) | 173 (100%) | 177 (100%) | no change |
Formulary tier
| Tier | 2026 plans | 2027 plans |
|---|---|---|
| Tier 5 | 41 (100%) | 48 (100%) |
Plan by plan, 2026 to 2027
| Plan by plan | Plans |
|---|---|
| Same plan ID in both years | 143 |
| Listed it in 2026, not in 2027 | 3 (2%) |
| Listed it in 2027, not in 2026 | 0 (0%) |
| Moved it to a higher tier | 0 (0%) |
| Moved it to a lower tier | 0 (0%) |
| Added prior authorization | 0 (0%) |
| Added step therapy | 0 (0%) |
| Added a quantity limit | 0 (0%) |
| Added at least one of the three | 0 (0%) |
| Removed at least one of the three | 0 (0%) |
| Plan IDs new in 2027 | 34 |
| 2026 plan IDs not in the 2027 file | 30 |
The CMS summary has no count of tier moves down, so "Moved it to a lower tier" is counted from the plan rows on this page: plans with the same plan ID in both years that list Gammaplex both years.
Restricted listings rose from 41 to 48, but none of the 143 plans offered in both years added prior authorization, step therapy, or a quantity limit to Gammaplex. The rise comes from plan IDs that are new in 2027: 34 new plan IDs, and 18 of them restrict it. 30 plan IDs from 2026 are not in the 2027 file.
Gammaplex in other states
- Alabama100% restrict or leave off, no changeAL
- Alaska100% restrict or leave off, no changeAK
- Arizona100% restrict or leave off, no changeAZ
- Arkansas100% restrict or leave off, no changeAR
- California100% restrict or leave off, +12 pointsCA
- Colorado100% restrict or leave off, +13 pointsCO
- Connecticut100% restrict or leave off, no changeCT
- Delaware100% restrict or leave off, no changeDE
- District of Columbia100% restrict or leave off, +12 pointsDC
- Florida100% restrict or leave off, no changeFL
- Georgia100% restrict or leave off, +5 pointsGA
- Hawaii100% restrict or leave off, +12 pointsHI
- Idaho100% restrict or leave off, no changeID
- Illinois100% restrict or leave off, no changeIL
- Indiana100% restrict or leave off, no changeIN
- Iowa100% restrict or leave off, no changeIA
- Kansas100% restrict or leave off, no changeKS
- Kentucky100% restrict or leave off, no changeKY
- Louisiana100% restrict or leave off, no changeLA
- Maine100% restrict or leave off, no changeME
- Maryland100% restrict or leave off, +16 pointsMD
- Massachusetts100% restrict or leave off, no changeMA
- Michigan100% restrict or leave off, no changeMI
- Minnesota100% restrict or leave off, no changeMN
- Mississippi100% restrict or leave off, no changeMS
- Missouri100% restrict or leave off, no changeMO
- Montana100% restrict or leave off, no changeMT
- Nebraska100% restrict or leave off, no changeNE
- Nevada100% restrict or leave off, no changeNV
- New Hampshire100% restrict or leave off, no changeNH
- New Jersey100% restrict or leave off, no changeNJ
- New Mexico100% restrict or leave off, no changeNM
- New York100% restrict or leave off, no changeNY
- North Dakota100% restrict or leave off, no changeND
- Ohio100% restrict or leave off, no changeOH
- Oklahoma100% restrict or leave off, no changeOK
- Oregon100% restrict or leave off, +4 pointsOR
- Pennsylvania100% restrict or leave off, no changePA
- Rhode Island100% restrict or leave off, no changeRI
- South Carolina100% restrict or leave off, no changeSC
- South Dakota100% restrict or leave off, no changeSD
- Tennessee100% restrict or leave off, no changeTN
- Texas100% restrict or leave off, no changeTX
- Utah100% restrict or leave off, no changeUT
- Vermont100% restrict or leave off, no changeVT
- Virginia100% restrict or leave off, +4 pointsVA
- Washington100% restrict or leave off, +15 pointsWA
- West Virginia100% restrict or leave off, no changeWV
- Wisconsin100% restrict or leave off, no changeWI
- Wyoming100% restrict or leave off, no changeWY
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 2026 Part D formulary file (basic drugs and plan information), as of September 30, 2026. Publisher page
Source: CMS CY2027 landscape file (states and parent organizations), as of September 30, 2026. Publisher page
Source: CMS CY2026 landscape file, as of September 25, 2025. Publisher page
Source: CMS Medicare Part D Spending by Drug, 2024 data, as of June 25, 2026. Publisher page
Source: US Census Bureau 2020 ZCTA to county relationship file (ZIP lookup), as of December 9, 2021. Publisher page