Medicare drug coverage

Praluent: 2027 Medicare Part D coverage

517 of 5,495 Part D plans (9%) list Praluent on their 2027 formulary, down 2 points from 2026. 100% of those require prior authorization, step therapy, or a quantity limit.

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2027 compared with 2026

Praluent is number 126 by total Medicare Part D spending in 2024 ($341 million). Plans that list it most often put it on tier 2. Counts use 3 RxNorm products for this name.

Praluent Part D coverage, 2026 and 2027
Measure20262027Change
Part D plans in the file5,5185,495-23
Plans that list it631 (11%)517 (9%)-2 points
Prior authorization (of plans that list it)631 (100%)517 (100%)no change
Step therapy (of plans that list it)0 (0%)0 (0%)no change
Quantity limit (of plans that list it)255 (40%)220 (43%)+2 points
Any of the three (of plans that list it)631 (100%)517 (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

Praluent formulary tier, 2026 and 2027
Tier2026 plans2027 plans
Tier 130 (5%)21 (4%)
Tier 20 (0%)268 (52%)
Tier 3563 (89%)193 (37%)
Tier 438 (6%)35 (7%)

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. 0 of them (0%) added prior authorization, step therapy, or a quantity limit for Praluent, and 49 stopped listing it.

Praluent: plans in both 2026 and 2027
Plan by planPlans
Same plan id in both years4,380
Listed it in 2026, not in 202749 (1%)
Listed it in 2027, not in 202627 (1%)
Moved it to a higher tier7 (0%)
Added prior authorization0 (0%)
Added step therapy0 (0%)
Added a quantity limit0 (0%)
Added at least one of the three0 (0%)
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 Praluent off the formulary or list it with prior authorization, step therapy, or a quantity limit. Massachusetts ranks first at 100%, with 50% of its plans using prior authorization or step therapy; Tennessee ranks last at 100%. Ties break on the prior authorization or step therapy share.

States from most to least restrictive for Praluent, 2027
RankState2027 plansNot listed or restrictedPrior auth or step therapyChange from 2026
1Massachusetts92100%50%no change
2Wyoming13100%38%no change
3Michigan183100%28%no change
4North Dakota26100%27%no change
5South Dakota30100%23%no change
6Alaska9100%22%no change
7Delaware43100%21%no change
8Nebraska51100%20%no change
9New Jersey74100%19%no change
10South Carolina91100%19%no change
11Minnesota63100%17%no change
12Iowa64100%17%no change
13Pennsylvania324100%17%no change
14Mississippi105100%14%no change
15Vermont14100%14%no change
16Nevada100100%14%no change
17Georgia151100%12%no change
18Maine52100%12%no change
19Connecticut54100%11%no change
20Montana27100%11%no change
21Oregon92100%11%no change
22Texas412100%11%no change
23Louisiana126100%10%no change
24District of Columbia21100%10%no change
25Arizona148100%9%no change
26Wisconsin97100%9%no change
27New Hampshire25100%8%no change
28Illinois133100%8%no change
29Kentucky123100%7%no change
30Florida549100%7%no change
31Arkansas86100%7%no change
32Rhode Island29100%7%no change
33North Carolina177100%7%no change
34New York215100%6%no change
35Hawaii50100%6%no change
36Kansas84100%6%no change
37Missouri171100%6%no change
38Indiana140100%6%no change
39Washington114100%5%no change
40Idaho45100%4%no change
41West Virginia70100%4%no change
42Maryland49100%4%no change
43California397100%4%no change
44Utah53100%4%no change
45Ohio173100%3%no change
46New Mexico68100%3%no change
47Oklahoma81100%2%no change
48Colorado106100%2%no change
49Alabama115100%2%no change
50Virginia145100%1%no change
51Tennessee157100%1%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 Praluent off or restrict it.

Praluent 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 Corporation268100%100%100%no change0
Health Care Service Corporation2310%none list it100%no change0
Kaiser Foundation Health Plan, Inc.1120%none list it100%no change0
Highmark Health987%100%100%no change0
SCAN Group850%none list it100%no change0
Alignment Healthcare USA, LLC770%none list it100%no change0
Guidewell Mutual Holding Corporation555%100%100%no change0
Blue Cross Blue Shield of Michigan Mutual Ins. Co.43100%100%100%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 CROSS3577%100%100%no change0
Medica Holding Company310%none list it100%no change0
UPMC Health System300%none list it100%no change0
Universal Health Services, Inc.29100%100%100%no change0
MHH Healthcare, L.P.260%none list it100%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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