Medicare drug coverage

Orencia: 2027 Medicare Part D coverage

636 of 5,495 Part D plans (12%) list Orencia on their 2027 formulary, down 11 points from 2026. 85% of those require prior authorization, step therapy, or a quantity limit.

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2027 compared with 2026

Orencia is number 84 by total Medicare Part D spending in 2024 ($570 million). Plans that list it most often put it on tier 5. Counts use 6 RxNorm products for this name.

Orencia Part D coverage, 2026 and 2027
Measure20262027Change
Part D plans in the file5,5185,495-23
Plans that list it1,259 (23%)636 (12%)-11 points
Prior authorization (of plans that list it)1,159 (92%)539 (85%)-7 points
Step therapy (of plans that list it)0 (0%)0 (0%)no change
Quantity limit (of plans that list it)954 (76%)450 (71%)-5 points
Any of the three (of plans that list it)1,159 (92%)539 (85%)-7 points
Not listed or restricted (of all plans)5,418 (98%)5,398 (98%)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

Orencia formulary tier, 2026 and 2027
Tier2026 plans2027 plans
Tier 1113 (9%)79 (12%)
Tier 22 (0%)1 (0%)
Tier 48 (1%)4 (1%)
Tier 51,136 (90%)552 (87%)

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. 3 of them (0%) added prior authorization, step therapy, or a quantity limit for Orencia, and 449 stopped listing it.

Orencia: plans in both 2026 and 2027
Plan by planPlans
Same plan id in both years4,380
Listed it in 2026, not in 2027449 (10%)
Listed it in 2027, not in 202625 (1%)
Moved it to a higher tier12 (0%)
Added prior authorization0 (0%)
Added step therapy0 (0%)
Added a quantity limit3 (0%)
Added at least one of the three3 (0%)
Removed at least one of the three1 (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 Orencia off the formulary or list it with prior authorization, step therapy, or a quantity limit. Massachusetts ranks first at 100%, with 48% of its plans using prior authorization or step therapy; Maryland ranks last at 80%. Ties break on the prior authorization or step therapy share.

States from most to least restrictive for Orencia, 2027
RankState2027 plansNot listed or restrictedPrior auth or step therapyChange from 2026
1Massachusetts92100%48%no change
2Pennsylvania324100%38%no change
3West Virginia70100%24%no change
4North Dakota26100%15%no change
5New York215100%15%no change
6New Jersey74100%15%no change
7North Carolina177100%15%no change
8South Dakota30100%13%no change
9South Carolina91100%13%no change
10Nevada100100%13%no change
11Iowa64100%13%no change
12Delaware43100%12%no change
13Nebraska51100%10%no change
14Florida549100%8%no change
15Texas412100%8%no change
16Ohio173100%8%no change
17Oklahoma81100%7%no change
18Minnesota63100%6%no change
19Arizona148100%6%no change
20Mississippi105100%5%no change
21New Mexico68100%4%no change
22Missouri171100%4%no change
23Indiana140100%4%no change
24Arkansas86100%3%no change
25Louisiana126100%3%no change
26Michigan183100%3%no change
27Alabama115100%3%no change
28Kansas84100%2%no change
29Idaho45100%2%no change
30Tennessee157100%2%no change
31Utah53100%2%no change
32Illinois133100%2%no change
33Kentucky123100%1%no change
34Alaska9100%0%no change
35Connecticut54100%0%no change
36Maine52100%0%no change
37Montana27100%0%no change
38New Hampshire25100%0%no change
39Rhode Island29100%0%no change
40Vermont14100%0%no change
41Wyoming13100%0%no change
42Wisconsin9799%4%no change
43Washington11497%15%no change
44Virginia14596%1%no change
45Oregon9296%5%no change
46Georgia15195%5%no change
47Colorado10690%4%+3 points
48Hawaii5088%2%+1 point
49California39788%5%no change
50District of Columbia2186%0%-2 points
51Maryland4980%4%-5 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 Orencia off or restrict it.

Orencia coverage by parent organization, 2027
Parent organization2027 plans ↓List itRestrict it (of listing)Not listed or restrictedChange from 2026Plans that added a restriction
Humana Inc.8840%none list it100%no change0
UnitedHealth Group, Inc.8500%100%100%no change0
Devoted Health, Inc.7280%none list it100%no change0
CVS Health Corporation6330%none list it100%no change0
Elevance Health, Inc.2940%none list it100%no change0
Centene Corporation2680%none list it100%no change0
Health Care Service Corporation2310%none list it100%no change0
Kaiser Foundation Health Plan, Inc.112100%14%14%no change0
Highmark Health9893%100%100%no change0
SCAN Group850%none list it100%no change0
Alignment Healthcare USA, LLC770%none list it100%no change0
Guidewell Mutual Holding Corporation5531%100%100%no change0
Blue Cross Blue Shield of Michigan Mutual Ins. Co.430%none list it100%no change0
Molina Healthcare, Inc.430%none list it100%no change0
Corewell Health400%none list it100%no change0
Zing Health Consolidator, Inc360%none list it100%no change0
CAPITAL BLUE CROSS350%none list it100%no change0
Medica Holding Company310%none list it100%no change0
UPMC Health System30100%100%100%no change0
Universal Health Services, Inc.29100%100%100%no change0
MHH Healthcare, L.P.2677%100%100%no change0
Independence Health Group, Inc.25100%100%100%no change0
Point32Health, Inc.23100%100%100%no change0
BlueCross BlueShield of Tennessee220%none list it100%no change0
California Physicians' Service220%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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