Medicare drug coverage

Opsumit: 2027 Medicare Part D coverage

213 of 5,495 Part D plans (4%) list Opsumit on their 2027 formulary, the plan's list of covered drugs (down 19 points from 2026). 100% 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).

License: a US government work, in the public domain (Public Domain Mark 1.0).

Data only, not plan advice. Confirm on Medicare.gov Plan Finder or 1-800-MEDICARE.

2027 compared with 2026

Opsumit is number 39 by total Medicare Part D spending in 2024 ($1.2 billion). 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.

Opsumit Part D coverage, 2026 and 2027
Measure20262027Change
Part D plans in the file5,5185,495-23
Plans that list it1,260 (23%)213 (4%)-19 points
Prior authorization (of plans that list it)1,260 (100%)213 (100%)no change
Step therapy (of plans that list it)0 (0%)0 (0%)no change
Quantity limit (of plans that list it)933 (74%)213 (100%)+26 points
Any of the three (of plans that list it)1,260 (100%)213 (100%)no change
Not listed or restricted (of all plans)5,518 (100%)5,495 (100%)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

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Formulary tier

Opsumit formulary tier, 2026 and 2027
Tier2026 plans2027 plans
Tier 161 (5%)0 (0%)
Tier 44 (0%)0 (0%)
Tier 51,195 (95%)213 (100%)

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. 54 of them (1%) added prior authorization, step therapy, or a quantity limit for Opsumit, and 855 stopped listing it.

Opsumit: plans in both 2026 and 2027
Plan by planPlans
Same plan ID in both years4,380
Listed it in 2026, not in 2027855 (20%)
Listed it in 2027, not in 20263 (0%)
Moved it to a higher tier0 (0%)
Added prior authorization0 (0%)
Added step therapy0 (0%)
Added a quantity limit54 (1%)
Added at least one of the three54 (1%)
Removed at least one of the three0 (0%)
Plan IDs new in 20271,115
2026 plan IDs not in the 2027 file1,138

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 Opsumit off the formulary or list it with prior authorization, step therapy, or a quantity limit. All 51 states are at 100%. 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.

States from most to least restrictive for Opsumit, 2027
RankState2027 plansNot listed or restrictedPrior auth or step therapyChange from 2026
1Pennsylvania324100%21%no change
2California397100%17%no change
3New York215100%15%no change
4West Virginia70100%11%no change
Tied 5Delaware43100%7%no change
Tied 5Massachusetts92100%7%no change
7Arizona148100%5%no change
Tied 8Nevada100100%4%no change
Tied 8Mississippi105100%4%no change
10Arkansas86100%3%no change
11Oregon92100%2%no change
Tied 12Texas412100%1%no change
Tied 12Washington114100%1%no change
Tied 14Alaska9100%0%no change
Tied 14Alabama115100%0%no change
Tied 14Colorado106100%0%no change
Tied 14Connecticut54100%0%no change
Tied 14District of Columbia21100%0%no change
Tied 14Florida549100%0%no change
Tied 14Georgia151100%0%no change
Tied 14Hawaii50100%0%no change
Tied 14Iowa64100%0%no change
Tied 14Idaho45100%0%no change
Tied 14Illinois133100%0%no change
Tied 14Indiana140100%0%no change
Tied 14Kansas84100%0%no change
Tied 14Kentucky123100%0%no change
Tied 14Louisiana126100%0%no change
Tied 14Maryland49100%0%no change
Tied 14Maine52100%0%no change
Tied 14Michigan183100%0%no change
Tied 14Minnesota63100%0%no change
Tied 14Missouri171100%0%no change
Tied 14Montana27100%0%no change
Tied 14North Carolina177100%0%no change
Tied 14North Dakota26100%0%no change
Tied 14Nebraska51100%0%no change
Tied 14New Hampshire25100%0%no change
Tied 14New Jersey74100%0%no change
Tied 14New Mexico68100%0%no change
Tied 14Ohio173100%0%no change
Tied 14Oklahoma81100%0%no change
Tied 14Rhode Island29100%0%no change
Tied 14South Carolina91100%0%no change
Tied 14South Dakota30100%0%no change
Tied 14Tennessee157100%0%no change
Tied 14Utah53100%0%no change
Tied 14Virginia145100%0%no change
Tied 14Vermont14100%0%no change
Tied 14Wisconsin97100%0%no change
Tied 14Wyoming13100%0%no change

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 Opsumit off or restrict it.

Opsumit coverage by parent organization, 2027
Parent organization2027 plans ↑List itRestrict it (of listing)Not listed or restrictedChange from 2026Plans that added a restriction
BrightSpring Health Services, Inc.20%none list it100%no change0
Community Health Group20%none list it100%no change0
Community Health Plan of Washington20%none list it100%no change0
Denver Health and Hospital Authority20%none list it100%no change0
Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT20%none list it100%no change0
Elite Health Systems, Inc.20%none list it100%no change0
Group Health Cooperative of Eau Claire20%none list it100%no change0
Hamaspik of Rockland County, Inc.20%none list it100%no change0
ISNP Holdings, LLC20%none list it100%no change0
Kansas Superior Select20%none list it100%no change0
Missouri Healthcare Advisors, LLC20%none list it100%no change0
MultiCare Health Systems20%none list it100%new in 20270
NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND20%none list it100%no change0
PrimeWest Rural MN Health Care Access Initiative20%none list it100%no change0
Regency ISNP Holdings LLC20%none list it100%no change0
Select Founders, LLC20%none list it100%no change0
Sentara Health Care (SHC)20%none list it100%no change0
South Country Health Alliance20%none list it100%no change0
The Regents of the University of California20%none list it100%no change0
Troy Holdings, Inc.20%none list it100%no change0
Associated Care Ventures, Inc.30%none list it100%no change0
Aultman Health Foundation30%none list it100%no change0
Banner Health30%none list it100%no change0
Bexar County Hospital District30%none list it100%no change0
Blue Cross Blue Shield of Nebraska30%none list it100%no change0

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

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