Medicare drug coverage

Privigen: 2027 Medicare Part D coverage

2,128 of 5,495 Part D plans (39%) list Privigen on their 2027 formulary, up 3 points from 2026. 100% of those require prior authorization, step therapy, or a quantity limit.

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2027 compared with 2026

Privigen is number 95 by total Medicare Part D spending in 2024 ($494 million). Plans that list it most often put it on tier 5. Counts use 5 RxNorm products for this name.

Privigen Part D coverage, 2026 and 2027
Measure20262027Change
Part D plans in the file5,5185,495-23
Plans that list it1,973 (36%)2,128 (39%)+3 points
Prior authorization (of plans that list it)1,973 (100%)2,128 (100%)no change
Step therapy (of plans that list it)0 (0%)0 (0%)no change
Quantity limit (of plans that list it)0 (0%)0 (0%)no change
Any of the three (of plans that list it)1,973 (100%)2,128 (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

Privigen formulary tier, 2026 and 2027
Tier2026 plans2027 plans
Tier 1106 (5%)96 (5%)
Tier 21 (0%)0 (0%)
Tier 47 (0%)4 (0%)
Tier 51,839 (93%)2,028 (95%)
Tier 620 (1%)0 (0%)

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 Privigen, and 53 stopped listing it.

Privigen: plans in both 2026 and 2027
Plan by planPlans
Same plan id in both years4,380
Listed it in 2026, not in 202753 (1%)
Listed it in 2027, not in 202633 (1%)
Moved it to a higher tier19 (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 Privigen off the formulary or list it with prior authorization, step therapy, or a quantity limit. Massachusetts ranks first at 100%, with 77% 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 Privigen, 2027
RankState2027 plansNot listed or restrictedPrior auth or step therapyChange from 2026
1Massachusetts92100%77%no change
2Pennsylvania324100%61%no change
3New York215100%57%no change
4Tennessee157100%52%no change
5Iowa64100%52%no change
6Hawaii50100%50%no change
7Alabama115100%47%no change
8North Carolina177100%47%no change
9Connecticut54100%46%no change
10Missouri171100%46%no change
11New Jersey74100%45%no change
12Nebraska51100%43%no change
13Kansas84100%43%no change
14West Virginia70100%43%no change
15Florida549100%43%no change
16Illinois133100%41%no change
17Maryland49100%41%no change
18Ohio173100%40%no change
19South Carolina91100%40%no change
20Arkansas86100%38%no change
21Delaware43100%37%no change
22Arizona148100%37%no change
23Oregon92100%37%no change
24Colorado106100%37%no change
25South Dakota30100%37%no change
26Indiana140100%36%no change
27Texas412100%35%no change
28Wisconsin97100%34%no change
29Utah53100%34%no change
30Mississippi105100%32%no change
31Georgia151100%31%no change
32Louisiana126100%31%no change
33Oklahoma81100%31%no change
34Washington114100%31%no change
35Nevada100100%27%no change
36North Dakota26100%27%no change
37Minnesota63100%25%no change
38Maine52100%25%no change
39Michigan183100%25%no change
40Rhode Island29100%24%no change
41New Hampshire25100%24%no change
42Virginia145100%23%no change
43Kentucky123100%22%no change
44New Mexico68100%19%no change
45District of Columbia21100%19%no change
46Vermont14100%14%no change
47Alaska9100%11%no change
48California397100%11%no change
49Idaho45100%9%no change
50Montana27100%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 Privigen off or restrict it.

Privigen coverage by parent organization, 2027
Parent organization2027 plans ↑List itRestrict it (of listing)Not listed or restrictedChange from 2026Plans that added a restriction
AIDS Healthcare Foundation10%none list it100%no change0
Alameda Alliance for Health10%none list it100%no change0
AllCare Health, Inc.10%none list it100%no change0
AlohaCare1100%100%100%no change0
BCBS MN, MT, NE, ND, WY, Wellmark IA and SD10%none list it100%no change0
CareOregon, Inc.1100%100%100%no change0
Contra Costa Health Services10%none list it100%no change0
DLP Marquette Health Plan, LLC10%none list it100%no change0
Health Plan of San Mateo10%none list it100%no change0
IMPERIAL COUNTY LOCAL HEALTH AUTHORITY10%none list it100%no change0
INLAND EMPIRE HEALTH PLAN10%none list it100%no change0
Itasca County1100%100%100%no change0
Kern Health Systems (KHS)10%none list it100%no change0
Local Initiative Health Authority for LA County1100%100%100%no change0
Muscogee Creek Nation1100%100%100%new in 20270
Orange County Health Authority10%none list it100%no change0
SAN FRANCISCO HEALTH AUTHORITY10%none list it100%no change0
SAN JOAQUIN COUNTY HEALTH COMMISSION10%none list it100%no change0
SANTA BARBARA SAN LUIS OBISPO REGIONAL HEALTH AUTH10%none list it100%no change0
SANTA CLARA COUNTY HEALTH AUTHORITY10%none list it100%no change0
SANTA CRUZ MONTEREY MERCED SAN BENITO MARIPOSA MAN10%none list it100%no change0
Samaritan Health Services, Inc.1100%100%100%no change0
The Schroer Group, Inc.10%none list it100%no change0
Ventura County Medi-Cal Managed Care Commission10%none list it100%no change0
BayCare Health System, Inc.2100%100%100%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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