Medicare drug coverage
Gemtesa: 2027 Medicare Part D coverage
4,376 of 5,495 Part D plans (80%) list Gemtesa on their 2027 formulary, the plan's list of covered drugs (the same share as 2026). 74% 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).
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Data only, not plan advice. Confirm on Medicare.gov Plan Finder or 1-800-MEDICARE.
2027 compared with 2026
Gemtesa is number 49 by total Medicare Part D spending in 2024 ($945 million). Plans that list it most often put it on tier 4 (a tier is the cost level a plan puts a drug on; a lower tier usually costs less). Counts use 2 RxNorm products for this name.
| Measure | 2026 | 2027 | Change |
|---|---|---|---|
| Part D plans in the file | 5,518 | 5,495 | -23 |
| Plans that list it | 4,429 (80%) | 4,376 (80%) | no change |
| Prior authorization (of plans that list it) | 13 (0%) | 1 (0%) | no change |
| Step therapy (of plans that list it) | 18 (0%) | 15 (0%) | no change |
| Quantity limit (of plans that list it) | 3,177 (72%) | 3,238 (74%) | +2 points |
| Any of the three (of plans that list it) | 3,195 (72%) | 3,238 (74%) | +2 points |
| Not listed or restricted (of all plans) | 4,284 (78%) | 4,357 (79%) | +1 point |
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
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.
Formulary tier
| Tier | 2026 plans | 2027 plans |
|---|---|---|
| Tier 1 | 123 (3%) | 93 (2%) |
| Tier 2 | 1 (0%) | 0 (0%) |
| Tier 3 | 1,531 (35%) | 2,084 (48%) |
| Tier 4 | 2,774 (63%) | 2,199 (50%) |
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. 77 of them (2%) added prior authorization, step therapy, or a quantity limit for Gemtesa, and 164 stopped listing it.
| Plan by plan | Plans |
|---|---|
| Same plan ID in both years | 4,380 |
| Listed it in 2026, not in 2027 | 164 (4%) |
| Listed it in 2027, not in 2026 | 19 (0%) |
| Moved it to a higher tier | 51 (1%) |
| Added prior authorization | 0 (0%) |
| Added step therapy | 1 (0%) |
| Added a quantity limit | 76 (2%) |
| Added at least one of the three | 77 (2%) |
| Removed at least one of the three | 12 (0%) |
| 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 Gemtesa off the formulary or list it with prior authorization, step therapy, or a quantity limit. Michigan ranks first at 92%, with 0% of its plans using prior authorization or step therapy; Massachusetts ranks last at 45%. 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 |
|---|---|---|---|---|---|
| 1 | Michigan | 183 | 92% | 0% | +1 point |
| 2 | Pennsylvania | 324 | 89% | 1% | +1 point |
| 3 | Florida | 549 | 89% | 0% | +4 points |
| 4 | Maryland | 49 | 88% | 0% | +5 points |
| 5 | Oregon | 92 | 87% | 1% | +8 points |
| 6 | South Carolina | 91 | 87% | 0% | +7 points |
| Tied 7 | Georgia | 151 | 86% | 0% | no change |
| Tied 7 | Alabama | 115 | 86% | 0% | no change |
| Tied 7 | Vermont | 14 | 86% | 0% | +1 point |
| Tied 10 | Tennessee | 157 | 85% | 0% | -3 points |
| Tied 10 | Montana | 27 | 85% | 0% | +7 points |
| Tied 10 | Wyoming | 13 | 85% | 0% | +17 points |
| Tied 13 | Hawaii | 50 | 84% | 0% | +7 points |
| Tied 13 | Arkansas | 86 | 84% | 0% | +2 points |
| 15 | Connecticut | 54 | 83% | 0% | +4 points |
| 16 | Indiana | 140 | 82% | 2% | +2 points |
| Tied 17 | Kansas | 84 | 82% | 0% | +4 points |
| Tied 17 | Mississippi | 105 | 82% | 0% | -4 points |
| 19 | North Carolina | 177 | 81% | 2% | +4 points |
| Tied 20 | Kentucky | 123 | 81% | 0% | -1 point |
| Tied 20 | New Jersey | 74 | 81% | 0% | +6 points |
| 22 | Iowa | 64 | 80% | 0% | +15 points |
| 23 | Arizona | 148 | 79% | 1% | +6 points |
| Tied 24 | Colorado | 106 | 79% | 0% | +5 points |
| Tied 24 | Delaware | 43 | 79% | 0% | no change |
| Tied 24 | West Virginia | 70 | 79% | 0% | -2 points |
| 27 | Missouri | 171 | 78% | 2% | +3 points |
| Tied 28 | Nebraska | 51 | 78% | 0% | +7 points |
| Tied 28 | Alaska | 9 | 78% | 0% | no change |
| Tied 28 | Texas | 412 | 78% | 0% | +3 points |
| 31 | Illinois | 133 | 77% | 1% | -1 point |
| 32 | Maine | 52 | 77% | 0% | +3 points |
| 33 | New York | 215 | 76% | 0% | +1 point |
| Tied 34 | Washington | 114 | 75% | 0% | +3 points |
| Tied 34 | Oklahoma | 81 | 75% | 0% | -5 points |
| 36 | Virginia | 145 | 74% | 0% | +3 points |
| 37 | California | 397 | 73% | 0% | -3 points |
| Tied 38 | Louisiana | 126 | 72% | 0% | +1 point |
| Tied 38 | New Hampshire | 25 | 72% | 0% | +24 points |
| Tied 38 | Utah | 53 | 72% | 0% | -2 points |
| 41 | Ohio | 173 | 71% | 0% | +1 point |
| 42 | District of Columbia | 21 | 67% | 0% | -5 points |
| 43 | Nevada | 100 | 66% | 0% | no change |
| 44 | Wisconsin | 97 | 65% | 0% | +14 points |
| 45 | Idaho | 45 | 64% | 0% | no change |
| 46 | Minnesota | 63 | 63% | 0% | -1 point |
| 47 | Rhode Island | 29 | 62% | 0% | +1 point |
| 48 | South Dakota | 30 | 60% | 0% | +10 points |
| 49 | New Mexico | 68 | 56% | 0% | -9 points |
| 50 | North Dakota | 26 | 54% | 0% | +15 points |
| 51 | Massachusetts | 92 | 45% | 0% | +7 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 Gemtesa 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 |
|---|---|---|---|---|---|---|
| BrightSpring Health Services, Inc. | 2 | 0% | none list it | 100% | no change | 0 |
| Community Health Group | 2 | 0% | none list it | 100% | no change | 0 |
| Community Health Plan of Washington | 2 | 100% | 0% | 0% | no change | 0 |
| Denver Health and Hospital Authority | 2 | 0% | none list it | 100% | no change | 0 |
| Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT | 2 | 100% | 100% | 100% | no change | 0 |
| Elite Health Systems, Inc. | 2 | 0% | none list it | 100% | no change | 0 |
| Group Health Cooperative of Eau Claire | 2 | 100% | 0% | 0% | no change | 0 |
| Hamaspik of Rockland County, Inc. | 2 | 0% | none list it | 100% | no change | 0 |
| ISNP Holdings, LLC | 2 | 100% | 100% | 100% | no change | 0 |
| Kansas Superior Select | 2 | 100% | 100% | 100% | no change | 0 |
| Missouri Healthcare Advisors, LLC | 2 | 100% | 100% | 100% | no change | 0 |
| MultiCare Health Systems | 2 | 100% | 100% | 100% | new in 2027 | 0 |
| NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND | 2 | 100% | 100% | 100% | no change | 0 |
| PrimeWest Rural MN Health Care Access Initiative | 2 | 0% | none list it | 100% | no change | 0 |
| Regency ISNP Holdings LLC | 2 | 0% | none list it | 100% | no change | 0 |
| Select Founders, LLC | 2 | 0% | none list it | 100% | no change | 0 |
| Sentara Health Care (SHC) | 2 | 0% | none list it | 100% | no change | 0 |
| South Country Health Alliance | 2 | 100% | 100% | 100% | no change | 0 |
| The Regents of the University of California | 2 | 0% | none list it | 100% | no change | 0 |
| Troy Holdings, Inc. | 2 | 0% | none list it | 100% | no change | 0 |
| Associated Care Ventures, Inc. | 3 | 100% | 100% | 100% | no change | 0 |
| Aultman Health Foundation | 3 | 100% | 0% | 0% | no change | 0 |
| Banner Health | 3 | 100% | 0% | 0% | no change | 0 |
| Bexar County Hospital District | 3 | 100% | 100% | 100% | no change | 0 |
| Blue Cross Blue Shield of Nebraska | 3 | 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