Medicare drug coverage

Opsumit: 2027 Medicare Part D coverage

213 of 5,495 Part D plans (4%) list Opsumit on their 2027 formulary, down 19 points from 2026. 100% of those require prior authorization, step therapy, or a quantity limit.

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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. 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

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. Pennsylvania ranks first at 100%, with 21% of its plans using prior authorization or step therapy; Wyoming ranks last at 100%. Ties break on the prior authorization or step therapy share.

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
5Delaware43100%7%no change
6Massachusetts92100%7%no change
7Arizona148100%5%no change
8Nevada100100%4%no change
9Mississippi105100%4%no change
10Arkansas86100%3%no change
11Oregon92100%2%no change
12Texas412100%1%no change
13Washington114100%1%no change
14Alaska9100%0%no change
15Alabama115100%0%no change
16Colorado106100%0%no change
17Connecticut54100%0%no change
18District of Columbia21100%0%no change
19Florida549100%0%no change
20Georgia151100%0%no change
21Hawaii50100%0%no change
22Iowa64100%0%no change
23Idaho45100%0%no change
24Illinois133100%0%no change
25Indiana140100%0%no change
26Kansas84100%0%no change
27Kentucky123100%0%no change
28Louisiana126100%0%no change
29Maryland49100%0%no change
30Maine52100%0%no change
31Michigan183100%0%no change
32Minnesota63100%0%no change
33Missouri171100%0%no change
34Montana27100%0%no change
35North Carolina177100%0%no change
36North Dakota26100%0%no change
37Nebraska51100%0%no change
38New Hampshire25100%0%no change
39New Jersey74100%0%no change
40New Mexico68100%0%no change
41Ohio173100%0%no change
42Oklahoma81100%0%no change
43Rhode Island29100%0%no change
44South Carolina91100%0%no change
45South Dakota30100%0%no change
46Tennessee157100%0%no change
47Utah53100%0%no change
48Virginia145100%0%no change
49Vermont14100%0%no change
50Wisconsin97100%0%no change
51Wyoming13100%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
Lifetime Healthcare, Inc.21100%100%100%no change0
Athena Healthcare Holdings, LLC190%none list it100%no change0
Mitchell Family Office190%none list it100%no change0
Risant Health, Inc.170%none list it100%no change0
Champion Health Plans-USA, LLC.160%none list it100%no change0
MEDICAL MUTUAL OF OHIO160%none list it100%no change0
Ultimate Healthcare Holdings, LLC160%none list it100%no change0
Gold Kidney Health Plan150%none list it100%no change0
Trinity Health Corporation150%none list it100%no change0
CuraCor Solutions Corp.140%none list it100%no change0
Lumeris Group Holdings Corporation140%none list it100%no change0
Rifkin Managed Care Holding, LLC140%none list it100%no change0
Sanford Health140%none list it100%no change0
University of Wisconsin Hospitals and Clincs Autho140%none list it100%no change0
Cambia Health Solutions, Inc.130%none list it100%no change0
Clover Health Holdings, Inc.130%none list it100%no change0
Henry Ford Health System130%none list it100%no change0
Curana Health Holdings, LLC120%none list it100%no change0
Fallon Community Health Plan, Inc.120%none list it100%no change0
Louisiana Health Service & Indemnity Company120%none list it100%no change0
ATRIO Health Plans110%none list it100%no change0
Aware Integrated, Inc.100%none list it100%no change0
Gemstone Holdings, Inc.100%none list it100%no change0
Intermountain Health Care, Inc.100%none list it100%no change0
Thomas Jefferson University100%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

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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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