Medicare drug coverage

Privigen: 2027 Medicare Part D coverage

2,128 of 5,495 Part D plans (39%) list Privigen on their 2027 formulary, the plan's list of covered drugs (up 3 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

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 (a tier is the cost level a plan puts a drug on; a lower tier usually costs less). 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

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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. 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 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
Tied 4Tennessee157100%52%no change
Tied 4Iowa64100%52%no change
6Hawaii50100%50%no change
Tied 7Alabama115100%47%no change
Tied 7North Carolina177100%47%no change
Tied 9Connecticut54100%46%no change
Tied 9Missouri171100%46%no change
11New Jersey74100%45%no change
Tied 12Nebraska51100%43%no change
Tied 12Kansas84100%43%no change
Tied 12West Virginia70100%43%no change
Tied 12Florida549100%43%no change
Tied 16Illinois133100%41%no change
Tied 16Maryland49100%41%no change
Tied 18Ohio173100%40%no change
Tied 18South Carolina91100%40%no change
20Arkansas86100%38%no change
Tied 21Delaware43100%37%no change
Tied 21Arizona148100%37%no change
Tied 21Oregon92100%37%no change
Tied 21Colorado106100%37%no change
Tied 21South Dakota30100%37%no change
26Indiana140100%36%no change
27Texas412100%35%no change
Tied 28Wisconsin97100%34%no change
Tied 28Utah53100%34%no change
30Mississippi105100%32%no change
Tied 31Georgia151100%31%no change
Tied 31Louisiana126100%31%no change
Tied 31Oklahoma81100%31%no change
Tied 31Washington114100%31%no change
Tied 35Nevada100100%27%no change
Tied 35North Dakota26100%27%no change
Tied 37Minnesota63100%25%no change
Tied 37Maine52100%25%no change
Tied 37Michigan183100%25%no change
Tied 40Rhode Island29100%24%no change
Tied 40New Hampshire25100%24%no change
42Virginia145100%23%no change
43Kentucky123100%22%no change
Tied 44New Mexico68100%19%no change
Tied 44District of Columbia21100%19%no change
46Vermont14100%14%no change
Tied 47Alaska9100%11%no change
Tied 47California397100%11%no change
49Idaho45100%9%no change
Tied 50Montana27100%0%no change
Tied 50Wyoming13100%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
CoxHealth30%none list it100%no change0
First Sacramento Capital Funding LLC3100%100%100%no change0
Imperial Health Plan of California30%none list it100%no change0
Liberty Healthcare Insurance3100%100%100%no change0
Marquis Companies I, Inc.3100%100%100%no change0
McLaren Health Care Corporation30%none list it100%no change0
MedCare Partners Holding, LLC30%none list it100%new in 20270
Mercy Care3100%100%100%no change0
New York City Health and Hospitals Corporation3100%100%100%no change0
Presbyterian Healthcare Services30%none list it100%no change0
SIHO Holding, Inc.30%none list it100%no change0
St. Luke's Health System, Inc.30%none list it100%new in 20270
VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK30%none list it100%no change0
Village Care of New York, Inc.30%none list it100%no change0
Visiting Nurse Service of New York30%none list it100%no change0
Chapters CareNu Inc4100%100%100%no change0
Chinese Hospital Association40%none list it100%no change0
El Paso County Hospital District4100%100%100%no change0
Elderplan, Inc.4100%100%100%no change0
Horizon Mutual Holdings, Inc40%none list it100%no change0
LMC Family Holdings, LLC4100%100%100%no change0
Montage Health4100%100%100%no change0
St Francis Health System & St John Health System4100%100%100%no change0
Blue Cross & Blue Shield of Rhode Island50%none list it100%no change0
BlueCross BlueShield of Alabama50%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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