Medicare drug coverage
Kesimpta: 2027 Medicare Part D coverage
4,718 of 5,495 Part D plans (86%) list Kesimpta on their 2027 formulary, the plan's list of covered drugs (up 3 points from 2026). 81% 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
Kesimpta is number 82 by total Medicare Part D spending in 2024 ($583 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 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 | 4,589 (83%) | 4,718 (86%) | +3 points |
| Prior authorization (of plans that list it) | 3,569 (78%) | 3,683 (78%) | no change |
| Step therapy (of plans that list it) | 6 (0%) | 6 (0%) | no change |
| Quantity limit (of plans that list it) | 3,623 (79%) | 3,777 (80%) | +1 point |
| Any of the three (of plans that list it) | 3,679 (80%) | 3,816 (81%) | +1 point |
| Not listed or restricted (of all plans) | 4,608 (84%) | 4,593 (84%) | 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
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 | 160 (3%) | 119 (3%) |
| Tier 4 | 49 (1%) | 44 (1%) |
| Tier 5 | 4,380 (95%) | 4,555 (97%) |
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. 15 of them (0%) added prior authorization, step therapy, or a quantity limit for Kesimpta, and 20 stopped listing it.
| Plan by plan | Plans |
|---|---|
| Same plan ID in both years | 4,380 |
| Listed it in 2026, not in 2027 | 20 (0%) |
| Listed it in 2027, not in 2026 | 58 (1%) |
| Moved it to a higher tier | 41 (1%) |
| Added prior authorization | 0 (0%) |
| Added step therapy | 0 (0%) |
| Added a quantity limit | 15 (0%) |
| Added at least one of the three | 15 (0%) |
| 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 Kesimpta off the formulary or list it with prior authorization, step therapy, or a quantity limit. 3 states tie for the highest share, 100%; New Mexico ranks last at 59%. The table breaks ties on the prior authorization or step therapy share.
| Rank | State | 2027 plans | Not listed or restricted | Prior auth or step therapy | Change from 2026 |
|---|---|---|---|---|---|
| 1 | Vermont | 14 | 100% | 43% | no change |
| 2 | Wyoming | 13 | 100% | 23% | +21 points |
| 3 | Alaska | 9 | 100% | 11% | no change |
| 4 | Michigan | 183 | 94% | 34% | +1 point |
| 5 | Pennsylvania | 324 | 94% | 74% | +1 point |
| 6 | South Dakota | 30 | 93% | 67% | no change |
| 7 | Montana | 27 | 93% | 56% | +7 points |
| 8 | Massachusetts | 92 | 90% | 75% | +5 points |
| 9 | Florida | 549 | 90% | 81% | +1 point |
| 10 | South Carolina | 91 | 89% | 71% | no change |
| 11 | Minnesota | 63 | 89% | 70% | no change |
| 12 | Arkansas | 86 | 88% | 71% | +2 points |
| 13 | Arizona | 148 | 88% | 74% | +3 points |
| 14 | Alabama | 115 | 88% | 78% | no change |
| 15 | West Virginia | 70 | 87% | 64% | -5 points |
| 16 | Connecticut | 54 | 87% | 65% | no change |
| 17 | Oregon | 92 | 87% | 67% | +2 points |
| 18 | Tennessee | 157 | 87% | 80% | -2 points |
| 19 | New Jersey | 74 | 86% | 66% | +2 points |
| 20 | Nebraska | 51 | 86% | 63% | -1 point |
| 21 | Illinois | 133 | 86% | 73% | no change |
| 22 | Indiana | 140 | 85% | 76% | +2 points |
| 23 | Ohio | 173 | 85% | 73% | +2 points |
| 24 | North Carolina | 177 | 85% | 68% | +3 points |
| 25 | North Dakota | 26 | 85% | 54% | no change |
| 26 | Kentucky | 123 | 85% | 72% | no change |
| 27 | Kansas | 84 | 85% | 69% | +5 points |
| 28 | Missouri | 171 | 84% | 74% | +3 points |
| 29 | Mississippi | 105 | 84% | 63% | -5 points |
| 30 | Delaware | 43 | 84% | 58% | +1 point |
| 31 | Louisiana | 126 | 83% | 67% | -3 points |
| 32 | Iowa | 64 | 83% | 58% | -2 points |
| 33 | Texas | 412 | 82% | 68% | +2 points |
| 34 | Georgia | 151 | 82% | 65% | -1 point |
| 35 | Nevada | 100 | 82% | 63% | -3 points |
| 36 | Maine | 52 | 81% | 60% | +3 points |
| 37 | New Hampshire | 25 | 80% | 52% | +8 points |
| 38 | California | 397 | 78% | 53% | no change |
| 39 | Oklahoma | 81 | 78% | 53% | -5 points |
| 40 | Washington | 114 | 77% | 64% | +3 points |
| 41 | New York | 215 | 76% | 66% | no change |
| 42 | Hawaii | 50 | 76% | 62% | +3 points |
| 43 | Utah | 53 | 75% | 55% | -3 points |
| 44 | Virginia | 145 | 72% | 63% | +4 points |
| 45 | Maryland | 49 | 71% | 51% | +1 point |
| 46 | Wisconsin | 97 | 71% | 56% | no change |
| 47 | Colorado | 106 | 71% | 56% | +8 points |
| 48 | Rhode Island | 29 | 69% | 24% | +1 point |
| 49 | Idaho | 45 | 69% | 33% | -3 points |
| 50 | District of Columbia | 21 | 62% | 24% | -6 points |
| 51 | New Mexico | 68 | 59% | 41% | -14 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 Kesimpta 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 |
|---|---|---|---|---|---|---|
| Humana Inc. | 884 | 88% | 100% | 100% | no change | 0 |
| UnitedHealth Group, Inc. | 850 | 91% | 0% | 9% | no change | 0 |
| Devoted Health, Inc. | 728 | 100% | 100% | 100% | no change | 0 |
| CVS Health Corporation | 633 | 97% | 100% | 100% | no change | 0 |
| Elevance Health, Inc. | 294 | 100% | 100% | 100% | no change | 0 |
| Centene Corporation | 268 | 0% | none list it | 100% | no change | 0 |
| Health Care Service Corporation | 231 | 98% | 100% | 100% | no change | 0 |
| Kaiser Foundation Health Plan, Inc. | 112 | 100% | 14% | 14% | no change | 0 |
| Highmark Health | 98 | 100% | 100% | 100% | no change | 0 |
| SCAN Group | 85 | 100% | 100% | 100% | no change | 0 |
| Alignment Healthcare USA, LLC | 77 | 0% | none list it | 100% | no change | 0 |
| Guidewell Mutual Holding Corporation | 55 | 95% | 100% | 100% | no change | 0 |
| Blue Cross Blue Shield of Michigan Mutual Ins. Co. | 43 | 0% | none list it | 100% | no change | 0 |
| Molina Healthcare, Inc. | 43 | 100% | 100% | 100% | no change | 0 |
| Corewell Health | 40 | 0% | none list it | 100% | no change | 0 |
| Zing Health Consolidator, Inc | 36 | 100% | 100% | 100% | no change | 0 |
| CAPITAL BLUE CROSS | 35 | 23% | 100% | 100% | no change | 0 |
| Medica Holding Company | 31 | 100% | 100% | 100% | no change | 0 |
| UPMC Health System | 30 | 100% | 100% | 100% | no change | 0 |
| Universal Health Services, Inc. | 29 | 100% | 100% | 100% | no change | 0 |
| MHH Healthcare, L.P. | 26 | 77% | 100% | 100% | no change | 0 |
| Independence Health Group, Inc. | 25 | 68% | 100% | 100% | no change | 9 |
| Point32Health, Inc. | 23 | 100% | 100% | 100% | no change | 0 |
| BlueCross BlueShield of Tennessee | 22 | 100% | 100% | 100% | no change | 0 |
| California Physicians' Service | 22 | 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