Medicare drug coverage
Imbruvica in North Carolina: 2027 Part D coverage
177 of 177 Part D plans offered in North Carolina (100%) list Imbruvica on their 2027 formulary, the plan's list of covered drugs (the same share as 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).
License: a US government work, in the public domain (Public Domain Mark 1.0).
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Every 2027 plan in North Carolina
Each Part D plan offered in North Carolina, with Imbruvica'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) | Tier 5 | Tier 5 | PA, QL | No change |
| Humana Gold Plus H1036-137 (HMO-POS) | H1036-137-000 | MA-PD (HMO-POS) | Tier 5 | Tier 5 | PA, QL | No change |
| Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) | H1036-167-000 | MA-PD (HMO D-SNP) | Tier 5 | Tier 5 | PA, QL | No change |
| Humana Gold Plus H1036-233 (HMO-POS) | H1036-233-000 | MA-PD (HMO-POS) | Tier 5 | Tier 5 | PA, QL | No change |
| Humana Dual Select H1036-307 (HMO D-SNP) | H1036-307-000 | MA-PD (HMO D-SNP) | Tier 5 | Tier 5 | PA, QL | No change |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | H1036-308-000 | MA-PD (HMO C-SNP) | Tier 5 | Tier 5 | PA, QL | No change |
| Humana Gold Plus Giveback H1036-318 (HMO-POS) | H1036-318-000 | MA-PD (HMO-POS) | Tier 5 | Tier 5 | PA, QL | No change |
| Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) | H1036-331-000 | MA-PD (HMO D-SNP) | Tier 5 | Tier 5 | PA, QL | No change |
| Humana Gold Plus H1036-335 (HMO-POS) | H1036-335-001 | MA-PD (HMO-POS) | Tier 5 | Tier 5 | PA, QL | No change |
| Humana Gold Plus H1036-335 (HMO-POS) | H1036-335-002 | MA-PD (HMO-POS) | Tier 5 | Tier 5 | PA, QL | No change |
| Humana Gold Plus Giveback H1036-343 (HMO-POS) | H1036-343-000 | MA-PD (HMO-POS) | New plan ID | Tier 5 | PA, QL | New plan ID in 2027 |
| UHC Dual Complete NC-Q1 (PPO D-SNP) | H1889-005-000 | MA-PD (PPO D-SNP) | Tier 5 | Tier 5 | PA, QL | No change |
| UHC Dual Complete NC-S2 (PPO D-SNP) | H1889-034-000 | MA-PD (PPO D-SNP) | Tier 5 | Tier 5 | PA, QL | No change |
| Wellcare Simple Open (PPO) | H1914-007-000 | MA-PD (PPO) | Tier 5 | Tier 5 | PA, QL | No change |
| Wellcare Carolina Complete Dual Liberty Open (PPO D-SNP) | H1914-008-000 | MA-PD (PPO D-SNP) | Tier 5 | Tier 5 | PA, QL | No change |
| Wellcare Assist Open (PPO) | H1914-009-000 | MA-PD (PPO) | Tier 5 | Tier 5 | PA, QL | No change |
| AARP Medicare Advantage from UHC NC-0001 (PPO) | H2001-090-000 | MA-PD (PPO) | Tier 5 | Tier 5 | PA, QL | No change |
| AARP Medicare Advantage from UHC NC-0004 (PPO) | H2001-102-000 | MA-PD (PPO) | Tier 5 | Tier 5 | PA, QL | No change |
| AARP Medicare Advantage from UHC NC-0016 (PPO) | H2406-034-000 | MA-PD (PPO) | Tier 5 | Tier 5 | PA, QL | No change |
| AARP Medicare Advantage from UHC NC-0017 (PPO) | H2406-098-000 | MA-PD (PPO) | Tier 5 | Tier 5 | PA, QL | No change |
| AARP Medicare Advantage from UHC NC-0019 (PPO) | H2406-115-000 | MA-PD (PPO) | Tier 5 | Tier 5 | PA, QL | No change |
| HealthTeam Advantage Thrive Plan (HMO) | H2624-005-000 | MA-PD (HMO) | New plan ID | Tier 5 | PA, QL | New plan ID in 2027 |
| Aetna Medicare Signature (HMO) | H3146-001-000 | MA-PD (HMO) | Tier 5 | Tier 5 | PA, QL | No change |
| Aetna Medicare Full Dual (HMO D-SNP) | H3146-002-000 | MA-PD (HMO D-SNP) | Tier 5 | Tier 5 | PA, QL | No change |
| Aetna Medicare Signature (HMO) | H3146-004-000 | MA-PD (HMO) | Tier 5 | Tier 5 | PA, QL | No change |
Data only, not plan advice. Confirm on Medicare.gov Plan Finder or 1-800-MEDICARE.
By dosage form
The 2027 formularies list Imbruvica by dosage form. A plan can cover one form and leave off or restrict another, so each form is counted on its own.
| Dosage form | Plans that list it | Restricted (of listing) | Most common tier |
|---|---|---|---|
| Oral capsule | 177 (100%) | 177 (100%) | Tier 5 |
| Oral suspension | 177 (100%) | 177 (100%) | Tier 5 |
| Oral tablet | 177 (100%) | 177 (100%) | Tier 5 |
North Carolina compared with the nation
100% of the 177 Part D plans offered in North Carolina leave Imbruvica off the 2027 formulary or restrict it, against 98% nationally (2 points higher). North Carolina is tied with 37 other states for rank 1 of 51, 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 | 173 (100%) | 177 (100%) | no change |
| Prior authorization (of plans that list it) | 173 (100%) | 177 (100%) | no change |
| Step therapy (of plans that list it) | 0 (0%) | 0 (0%) | no change |
| Quantity limit (of plans that list it) | 171 (99%) | 177 (100%) | +1 point |
| Any of the three (of plans that list it) | 173 (100%) | 177 (100%) | no change |
| Not listed or restricted (of all plans) | 173 (100%) | 177 (100%) | no change |
Formulary tier
| Tier | 2026 plans | 2027 plans |
|---|---|---|
| Tier 1 | 8 (5%) | 6 (3%) |
| Tier 5 | 165 (95%) | 171 (97%) |
Plan by plan, 2026 to 2027
| Plan by plan | Plans |
|---|---|
| Same plan ID in both years | 143 |
| Listed it in 2026, not in 2027 | 0 (0%) |
| Listed it in 2027, not in 2026 | 0 (0%) |
| Moved it to a higher tier | 2 (1%) |
| Moved it to a lower tier | 0 (0%) |
| Added prior authorization | 0 (0%) |
| Added step therapy | 0 (0%) |
| Added a quantity limit | 2 (1%) |
| Added at least one of the three | 2 (1%) |
| 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 Imbruvica both years.
Imbruvica 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
- California88% restrict or leave off, no changeCA
- Colorado90% restrict or leave off, +3 pointsCO
- Connecticut100% restrict or leave off, no changeCT
- Delaware100% restrict or leave off, no changeDE
- District of Columbia86% restrict or leave off, -2 pointsDC
- Florida100% restrict or leave off, no changeFL
- Georgia95% restrict or leave off, no changeGA
- Hawaii88% restrict or leave off, no changeHI
- 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
- Maryland80% restrict or leave off, -4 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
- Nevada97% restrict or leave off, -3 pointsNV
- 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
- Oregon96% restrict or leave off, no changeOR
- 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
- Virginia96% restrict or leave off, no changeVA
- Washington86% restrict or leave off, +1 pointWA
- West Virginia100% restrict or leave off, no changeWV
- Wisconsin99% 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