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.
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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 (<1%) | 6 (<1%) | 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
Every 2027 stand-alone drug plan
Each stand-alone Part D plan (PDP) with Kesimpta's 2027 tier and limits. CMS files a PDP once per region, so one plan name can have several plan IDs; the row shows the tier and limits most of them use. Medicare Advantage drug plans are local: pick a state for its plan-by-plan table.
| Plan (PDP) | Plan IDs | 2027 tier | 2027 limits |
|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP) | 39 | Not listed | Not listed |
| AARP Medicare Rx Saver from UHC (PDP) | 34 | Not listed | Not listed |
| Blue Medicare Rx Enhanced (PDP) | 1 | Tier 5 | PA, QL |
| Blue Medicare Rx Standard (PDP) | 1 | Tier 5 | PA, QL |
| Blue MedicareRx Essentials (PDP) | 1 | Tier 5 | PA, QL |
| Blue MedicareRx Plus (PDP) | 1 | Tier 5 | PA, QL |
| Blue MedicareRx Premier (PDP) | 1 | Tier 5 | PA, QL |
| Blue MedicareRx Value (PDP) | 1 | Tier 5 | PA, QL |
| Blue MedicareRx Value Plus (PDP) | 1 | Not listed | Not listed |
| Blue Shield Rx Enhanced (PDP) | 1 | Not listed | Not listed |
| Blue Shield Rx Plus (PDP) | 1 | Not listed | Not listed |
| BlueMedicare Complete Rx (PDP) | 1 | Tier 5 | PA, QL |
| BlueMedicare Premier Rx (PDP) | 2 | Tier 5 | PA, QL |
| BlueMedicare Value Rx (PDP) | 1 | Not listed | Not listed |
| BlueRx Enhanced Plus (PDP) | 1 | Tier 5 | PA, QL |
| BlueRx Essential (PDP) | 1 | Tier 5 | PA, QL |
| HealthSpring Assurance Rx (PDP) | 35 | Tier 5 | PA, QL |
| HealthSpring Extra Rx (PDP) | 2 | Not listed | Not listed |
| HealthSpring Extra RX (PDP) | 3 | Not listed | Not listed |
| Horizon Medicare Blue Rx Enhanced (PDP) | 1 | Tier 5 | PA, QL |
| Horizon Medicare Blue Rx Standard (PDP) | 1 | Tier 5 | PA, QL |
| Humana Basic Rx Plan (PDP) | 34 | Not listed | Not listed |
| Humana Premier Rx Plan (PDP) | 34 | Not listed | Not listed |
| Humana Value Rx Plan (PDP) | 34 | Not listed | Not listed |
| MedicareBlue Rx Standard (PDP) | 1 | Not listed | Not listed |
| Prescription Blue Premium (PDP) | 1 | Not listed | Not listed |
| Prescription Blue Select (PDP) | 1 | Not listed | Not listed |
| SilverScript Choice (PDP) | 20 | Not listed | Not listed |
| Wellcare Classic (PDP) | 34 | Not listed | Not listed |
| Wellcare Value Script (PDP) | 34 | Not listed | Not listed |
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
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 (<1%) 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 (<1%) |
| 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 (<1%) |
| Added at least one of the three | 15 (<1%) |
| Removed at least one of the three | 12 (<1%) |
| 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%. 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 | Vermont | 14 | 100% | 43% | no change |
| 2 | Wyoming | 13 | 100% | 23% | +21 points |
| 3 | Alaska | 9 | 100% | 11% | no change |
| 4 | Pennsylvania | 324 | 94% | 74% | +1 point |
| 5 | Michigan | 183 | 94% | 34% | +1 point |
| 6 | South Dakota | 30 | 93% | 67% | no change |
| 7 | Montana | 27 | 93% | 56% | +7 points |
| 8 | Florida | 549 | 90% | 81% | +1 point |
| 9 | Massachusetts | 92 | 90% | 75% | +5 points |
| 10 | South Carolina | 91 | 89% | 71% | no change |
| 11 | Minnesota | 63 | 89% | 70% | no change |
| 12 | Alabama | 115 | 88% | 78% | no change |
| 13 | Arizona | 148 | 88% | 74% | +3 points |
| 14 | Arkansas | 86 | 88% | 71% | +2 points |
| 15 | Tennessee | 157 | 87% | 80% | -2 points |
| 16 | Oregon | 92 | 87% | 67% | +2 points |
| 17 | Connecticut | 54 | 87% | 65% | no change |
| 18 | West Virginia | 70 | 87% | 64% | -5 points |
| 19 | Illinois | 133 | 86% | 73% | no change |
| 20 | New Jersey | 74 | 86% | 66% | +2 points |
| 21 | Nebraska | 51 | 86% | 63% | -1 point |
| 22 | Indiana | 140 | 85% | 76% | +2 points |
| 23 | Ohio | 173 | 85% | 73% | +2 points |
| 24 | Kentucky | 123 | 85% | 72% | no change |
| 25 | Kansas | 84 | 85% | 69% | +5 points |
| 26 | North Carolina | 177 | 85% | 68% | +3 points |
| 27 | North Dakota | 26 | 85% | 54% | no change |
| 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 |
| Tied 38 | California | 397 | 78% | 53% | no change |
| Tied 38 | 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 |
| Tied 45 | Wisconsin | 97 | 71% | 56% | no change |
| Tied 45 | Colorado | 106 | 71% | 56% | +8 points |
| 47 | Maryland | 49 | 71% | 51% | +1 point |
| 48 | Idaho | 45 | 69% | 33% | -3 points |
| 49 | Rhode Island | 29 | 69% | 24% | +1 point |
| 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 |
|---|---|---|---|---|---|---|
| BrightSpring Health Services, Inc. | 2 | 100% | 100% | 100% | no change | 0 |
| Community Health Group | 2 | 100% | 100% | 100% | no change | 0 |
| Community Health Plan of Washington | 2 | 100% | 100% | 100% | no change | 0 |
| Denver Health and Hospital Authority | 2 | 50% | 100% | 100% | no change | 0 |
| Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT | 2 | 50% | 100% | 100% | no change | 0 |
| Elite Health Systems, Inc. | 2 | 100% | 100% | 100% | no change | 0 |
| Group Health Cooperative of Eau Claire | 2 | 100% | 100% | 100% | no change | 0 |
| Hamaspik of Rockland County, Inc. | 2 | 100% | 100% | 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 | 100% | 100% | 100% | no change | 0 |
| Regency ISNP Holdings LLC | 2 | 100% | 100% | 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 | 2 |
| The Regents of the University of California | 2 | 100% | 100% | 100% | no change | 0 |
| Troy Holdings, Inc. | 2 | 100% | 100% | 100% | no change | 2 |
| Associated Care Ventures, Inc. | 3 | 100% | 100% | 100% | no change | 0 |
| Aultman Health Foundation | 3 | 0% | none list it | 100% | no change | 0 |
| Banner Health | 3 | 100% | 100% | 100% | no change | 0 |
| Bexar County Hospital District | 3 | 100% | 100% | 100% | no change | 0 |
| Blue Cross Blue Shield of Nebraska | 3 | 100% | 100% | 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