Medicare drug coverage
Kesimpta in New York: 2027 Part D coverage
193 of 215 Part D plans offered in New York (90%) list Kesimpta on their 2027 formulary, the plan's list of covered drugs (up 3 points from 2026). 74% of those require prior authorization, step therapy, or a quantity limit. Plan counts include both Medicare Advantage plans with drug coverage (206 MA-PD) and stand-alone drug plans (9 PDP).
License: a US government work, in the public domain (Public Domain Mark 1.0).
For pharmacies and agencies: check a whole drug list against 2027 formularies.
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Every 2027 plan in New York
Each Part D plan offered in New York, with Kesimpta'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 |
|---|---|---|---|---|---|---|
| Hamaspik Medicare Select (HMO D-SNP) | H0034-001-000 | MA-PD (HMO D-SNP) | Tier 1 | Tier 1 | PA, QL | No change |
| Hamaspik Medicare Choice (HMO D-SNP) | H0034-002-000 | MA-PD (HMO D-SNP) | Tier 1 | Tier 1 | PA, QL | No change |
| MetroPlus Advantage Plan (HMO D-SNP) | H0423-001-000 | MA-PD (HMO D-SNP) | Tier 5 | Tier 5 | PA, QL | No change |
| MetroPlus Platinum Plan (HMO) | H0423-004-000 | MA-PD (HMO) | Tier 1 | Tier 1 | PA, QL | No change |
| MetroPlus UltraCare (HMO D-SNP) | H0423-007-000 | MA-PD (HMO D-SNP) | Tier 1 | Tier 1 | PA, QL | No change |
| Healthfirst Signature (HMO) | H1722-002-000 | MA-PD (HMO) | Tier 5 | Tier 5 | PA, QL | No change |
| UHC Dual Complete NY-S001 (PPO D-SNP) | H2001-063-001 | MA-PD (PPO D-SNP) | Tier 5 | Tier 5 | None | No change |
| UHC Dual Complete NY-S001 (PPO D-SNP) | H2001-063-002 | MA-PD (PPO D-SNP) | Tier 5 | Tier 5 | None | No change |
| VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) | H2168-001-000 | MA-PD (HMO D-SNP) | Tier 5 | Tier 5 | PA, QL | No change |
| VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) | H2168-002-000 | MA-PD (HMO D-SNP) | Tier 5 | Tier 5 | PA, QL | No change |
| VillageCareMAX Medicare Select Advantage Plan (HMO) | H2168-004-000 | MA-PD (HMO) | Tier 5 | Tier 5 | PA, QL | No change |
| UHC Nursing Home Plan NY-F001 (PPO I-SNP) | H2292-001-000 | MA-PD (PPO I-SNP) | Tier 5 | Tier 5 | None | No change |
| UHC Nursing Home Plan NY-F002 (PPO I-SNP) | H2292-002-000 | MA-PD (PPO I-SNP) | Tier 5 | Tier 5 | None | No change |
| Wellcare Simple Open (PPO) | H2775-106-000 | MA-PD (PPO) | Not listed | Not listed | Not listed | Not listed either year |
| Wellcare Giveback Open (PPO) | H2775-111-000 | MA-PD (PPO) | Not listed | Not listed | Not listed | Not listed either year |
| Wellcare Dual Access Open (PPO D-SNP) | H2775-112-000 | MA-PD (PPO D-SNP) | Not listed | Not listed | Not listed | Not listed either year |
| Wellcare Assist Open (PPO) | H2775-113-000 | MA-PD (PPO) | Not listed | Not listed | Not listed | Not listed either year |
| MVP Medicare Preferred Gold with Part D (HMO-POS) | H3305-015-000 | MA-PD (HMO-POS) | Tier 5 | Tier 5 | PA, QL | No change |
| MVP Medicare Secure Plus with Part D (HMO-POS) | H3305-022-000 | MA-PD (HMO-POS) | Tier 5 | Tier 5 | PA, QL | No change |
| MVP DualAccess (HMO D-SNP) | H3305-033-000 | MA-PD (HMO D-SNP) | Tier 5 | Tier 5 | PA, QL | No change |
| MVP DualAccess Complete (HMO D-SNP) | H3305-034-000 | MA-PD (HMO D-SNP) | Tier 5 | Tier 5 | PA, QL | No change |
| MVP Medicare WellValue with Part D (HMO-POS) | H3305-038-000 | MA-PD (HMO-POS) | New plan ID | Tier 5 | PA, QL | New plan ID in 2027 |
| MVP Medicare WellValue with Part D (HMO-POS) | H3305-039-000 | MA-PD (HMO-POS) | New plan ID | Tier 5 | PA, QL | New plan ID in 2027 |
| Aetna Medicare Signature (HMO) | H3312-002-000 | MA-PD (HMO) | Tier 5 | Tier 5 | PA, QL | No change |
| Aetna Medicare Enhanced (HMO-POS) | H3312-018-000 | MA-PD (HMO-POS) | Tier 5 | Tier 5 | PA, QL | No change |
Data only, not plan advice. Confirm on Medicare.gov Plan Finder or 1-800-MEDICARE.
New York compared with the nation
76% of the 215 Part D plans offered in New York leave Kesimpta off the 2027 formulary or restrict it, against 84% nationally (8 points lower). New York ranks 41 of 51 states from most to least restrictive; it shares its 76% with 1 other state, and the prior authorization or step therapy share sets the order among them. A plan offered in several states counts in each.
2027 compared with 2026
| Measure | 2026 | 2027 | Change |
|---|---|---|---|
| Part D plans in the file | 206 | 215 | +9 |
| Plans that list it | 179 (87%) | 193 (90%) | +3 points |
| Prior authorization (of plans that list it) | 130 (73%) | 141 (73%) | no change |
| Step therapy (of plans that list it) | 0 (0%) | 0 (0%) | no change |
| Quantity limit (of plans that list it) | 130 (73%) | 142 (74%) | +1 point |
| Any of the three (of plans that list it) | 130 (73%) | 142 (74%) | +1 point |
| Not listed or restricted (of all plans) | 157 (76%) | 164 (76%) | no change |
Formulary tier
| Tier | 2026 plans | 2027 plans |
|---|---|---|
| Tier 1 | 14 (8%) | 14 (7%) |
| Tier 4 | 2 (1%) | 2 (1%) |
| Tier 5 | 163 (91%) | 177 (92%) |
Plan by plan, 2026 to 2027
| Plan by plan | Plans |
|---|---|
| Same plan ID in both years | 148 |
| Listed it in 2026, not in 2027 | 0 (0%) |
| 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 | 1 (1%) |
| Plan IDs new in 2027 | 67 |
| 2026 plan IDs not in the 2027 file | 58 |
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 Kesimpta both years.
Restricted listings rose from 130 to 142, but none of the 148 plans offered in both years added prior authorization, step therapy, or a quantity limit to Kesimpta. The rise comes from plan IDs that are new in 2027: 67 new plan IDs, and 50 of them restrict it. 58 plan IDs from 2026 are not in the 2027 file.
Kesimpta in other states
- Alabama88% restrict or leave off, no changeAL
- Alaska100% restrict or leave off, no changeAK
- Arizona88% restrict or leave off, +3 pointsAZ
- Arkansas88% restrict or leave off, +2 pointsAR
- California78% restrict or leave off, no changeCA
- Colorado71% restrict or leave off, +8 pointsCO
- Connecticut87% restrict or leave off, no changeCT
- Delaware84% restrict or leave off, +1 pointDE
- District of Columbia62% restrict or leave off, -6 pointsDC
- Florida90% restrict or leave off, +1 pointFL
- Georgia82% restrict or leave off, -1 pointGA
- Hawaii76% restrict or leave off, +3 pointsHI
- Idaho69% restrict or leave off, -3 pointsID
- Illinois86% restrict or leave off, no changeIL
- Indiana85% restrict or leave off, +2 pointsIN
- Iowa83% restrict or leave off, -2 pointsIA
- Kansas85% restrict or leave off, +5 pointsKS
- Kentucky85% restrict or leave off, no changeKY
- Louisiana83% restrict or leave off, -3 pointsLA
- Maine81% restrict or leave off, +3 pointsME
- Maryland71% restrict or leave off, +1 pointMD
- Massachusetts90% restrict or leave off, +5 pointsMA
- Michigan94% restrict or leave off, +1 pointMI
- Minnesota89% restrict or leave off, no changeMN
- Mississippi84% restrict or leave off, -5 pointsMS
- Missouri84% restrict or leave off, +3 pointsMO
- Montana93% restrict or leave off, +7 pointsMT
- Nebraska86% restrict or leave off, -1 pointNE
- Nevada82% restrict or leave off, -3 pointsNV
- New Hampshire80% restrict or leave off, +8 pointsNH
- New Jersey86% restrict or leave off, +2 pointsNJ
- New Mexico59% restrict or leave off, -14 pointsNM
- North Carolina85% restrict or leave off, +3 pointsNC
- North Dakota85% restrict or leave off, no changeND
- Ohio85% restrict or leave off, +2 pointsOH
- Oklahoma78% restrict or leave off, -5 pointsOK
- Oregon87% restrict or leave off, +2 pointsOR
- Pennsylvania94% restrict or leave off, +1 pointPA
- Rhode Island69% restrict or leave off, +1 pointRI
- South Carolina89% restrict or leave off, no changeSC
- South Dakota93% restrict or leave off, no changeSD
- Tennessee87% restrict or leave off, -2 pointsTN
- Texas82% restrict or leave off, +2 pointsTX
- Utah75% restrict or leave off, -3 pointsUT
- Vermont100% restrict or leave off, no changeVT
- Virginia72% restrict or leave off, +4 pointsVA
- Washington77% restrict or leave off, +3 pointsWA
- West Virginia87% restrict or leave off, -5 pointsWV
- Wisconsin71% restrict or leave off, no changeWI
- Wyoming100% restrict or leave off, +21 pointsWY
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