Medicare drug coverage
Qulipta: 2027 Medicare Part D coverage
3,394 of 5,495 Part D plans (62%) list Qulipta on their 2027 formulary, down 11 points from 2026. 97% of those require prior authorization, step therapy, or a quantity limit.
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2027 compared with 2026
Qulipta is number 156 by total Medicare Part D spending in 2024 ($260 million). Plans that list it most often put it on tier 3. Counts use 4 RxNorm products for this name.
| Measure | 2026 | 2027 | Change |
|---|---|---|---|
| Part D plans in the file | 5,518 | 5,495 | -23 |
| Plans that list it | 4,031 (73%) | 3,394 (62%) | -11 points |
| Prior authorization (of plans that list it) | 3,911 (97%) | 3,289 (97%) | no change |
| Step therapy (of plans that list it) | 0 (0%) | 0 (0%) | no change |
| Quantity limit (of plans that list it) | 3,890 (97%) | 3,281 (97%) | no change |
| Any of the three (of plans that list it) | 3,931 (98%) | 3,297 (97%) | no change |
| 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
| Tier | 2026 plans | 2027 plans |
|---|---|---|
| Tier 1 | 100 (2%) | 95 (3%) |
| Tier 2 | 12 (0%) | 8 (0%) |
| Tier 3 | 1,905 (47%) | 2,130 (63%) |
| Tier 4 | 975 (24%) | 951 (28%) |
| Tier 5 | 1,039 (26%) | 210 (6%) |
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. 31 of them (1%) added prior authorization, step therapy, or a quantity limit for Qulipta, and 781 stopped listing it.
| Plan by plan | Plans |
|---|---|
| Same plan id in both years | 4,380 |
| Listed it in 2026, not in 2027 | 781 (18%) |
| Listed it in 2027, not in 2026 | 87 (2%) |
| Moved it to a higher tier | 45 (1%) |
| Added prior authorization | 12 (0%) |
| Added step therapy | 0 (0%) |
| Added a quantity limit | 19 (0%) |
| Added at least one of the three | 31 (1%) |
| Removed at least one of the three | 1 (0%) |
| Plan ids new in 2027 | 1,115 |
| 2026 plan ids not in the 2027 file | 1,138 |
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 Qulipta off the formulary or list it with prior authorization, step therapy, or a quantity limit. West Virginia ranks first at 100%, with 79% of its plans using prior authorization or step therapy; Maryland ranks last at 80%. Ties break on the prior authorization or step therapy share.
| Rank | State | 2027 plans | Not listed or restricted | Prior auth or step therapy | Change from 2026 |
|---|---|---|---|---|---|
| 1 | West Virginia | 70 | 100% | 79% | no change |
| 2 | Indiana | 140 | 100% | 77% | no change |
| 3 | Missouri | 171 | 100% | 74% | no change |
| 4 | Kentucky | 123 | 100% | 72% | no change |
| 5 | Pennsylvania | 324 | 100% | 71% | no change |
| 6 | Louisiana | 126 | 100% | 71% | no change |
| 7 | Connecticut | 54 | 100% | 70% | no change |
| 8 | Tennessee | 157 | 100% | 70% | no change |
| 9 | Illinois | 133 | 100% | 69% | no change |
| 10 | Massachusetts | 92 | 100% | 68% | no change |
| 11 | Kansas | 84 | 100% | 68% | no change |
| 12 | Ohio | 173 | 100% | 67% | no change |
| 13 | Oklahoma | 81 | 100% | 67% | no change |
| 14 | Arkansas | 86 | 100% | 65% | no change |
| 15 | Alabama | 115 | 100% | 64% | no change |
| 16 | Vermont | 14 | 100% | 64% | no change |
| 17 | Maine | 52 | 100% | 63% | no change |
| 18 | Montana | 27 | 100% | 63% | no change |
| 19 | Arizona | 148 | 100% | 61% | no change |
| 20 | Texas | 412 | 100% | 61% | no change |
| 21 | Iowa | 64 | 100% | 61% | no change |
| 22 | New Hampshire | 25 | 100% | 60% | no change |
| 23 | Nevada | 100 | 100% | 60% | no change |
| 24 | New York | 215 | 100% | 59% | no change |
| 25 | Michigan | 183 | 100% | 58% | no change |
| 26 | Florida | 549 | 100% | 58% | no change |
| 27 | North Carolina | 177 | 100% | 57% | no change |
| 28 | Utah | 53 | 100% | 57% | no change |
| 29 | South Carolina | 91 | 100% | 56% | no change |
| 30 | New Jersey | 74 | 100% | 55% | no change |
| 31 | Wyoming | 13 | 100% | 54% | no change |
| 32 | Delaware | 43 | 100% | 53% | no change |
| 33 | Mississippi | 105 | 100% | 52% | no change |
| 34 | Nebraska | 51 | 100% | 51% | no change |
| 35 | Alaska | 9 | 100% | 44% | no change |
| 36 | New Mexico | 68 | 100% | 40% | no change |
| 37 | Rhode Island | 29 | 100% | 34% | no change |
| 38 | Idaho | 45 | 100% | 33% | no change |
| 39 | South Dakota | 30 | 100% | 33% | no change |
| 40 | Minnesota | 63 | 100% | 29% | no change |
| 41 | North Dakota | 26 | 100% | 23% | no change |
| 42 | Wisconsin | 97 | 99% | 59% | no change |
| 43 | Washington | 114 | 97% | 61% | no change |
| 44 | Virginia | 145 | 96% | 63% | no change |
| 45 | Oregon | 92 | 96% | 62% | no change |
| 46 | Georgia | 151 | 95% | 56% | no change |
| 47 | Colorado | 106 | 90% | 56% | +3 points |
| 48 | Hawaii | 50 | 88% | 64% | +1 point |
| 49 | California | 397 | 88% | 39% | no change |
| 50 | District of Columbia | 21 | 86% | 38% | -2 points |
| 51 | Maryland | 49 | 80% | 55% | -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 Qulipta off or restrict it.
| Parent organization | 2027 plans ↑ | List it | Restrict it (of listing) | Not listed or restricted | Change from 2026 | Plans that added a restriction |
|---|---|---|---|---|---|---|
| BrightSpring Health Services, Inc. | 2 | 100% | 100% | 100% | no change | 0 |
| Community Health Group | 2 | 100% | 100% | 100% | no change | 0 |
| Community Health Plan of Washington | 2 | 0% | none list it | 100% | no change | 0 |
| Denver Health and Hospital Authority | 2 | 100% | 100% | 100% | no change | 0 |
| Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT | 2 | 100% | 100% | 100% | no change | 0 |
| Elite Health Systems, Inc. | 2 | 100% | 100% | 100% | no change | 0 |
| Group Health Cooperative of Eau Claire | 2 | 0% | none list it | 100% | no change | 0 |
| Hamaspik of Rockland County, Inc. | 2 | 100% | 100% | 100% | no change | 0 |
| ISNP Holdings, LLC | 2 | 100% | 100% | 100% | no change | 0 |
| Kansas Superior Select | 2 | 100% | 100% | 100% | no change | 0 |
| Missouri Healthcare Advisors, LLC | 2 | 100% | 100% | 100% | no change | 0 |
| MultiCare Health Systems | 2 | 100% | 100% | 100% | new in 2027 | 0 |
| NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND | 2 | 100% | 100% | 100% | no change | 0 |
| PrimeWest Rural MN Health Care Access Initiative | 2 | 100% | 100% | 100% | no change | 0 |
| Regency ISNP Holdings LLC | 2 | 100% | 100% | 100% | no change | 0 |
| Select Founders, LLC | 2 | 100% | 100% | 100% | no change | 0 |
| Sentara Health Care (SHC) | 2 | 100% | 100% | 100% | no change | 0 |
| South Country Health Alliance | 2 | 0% | none list it | 100% | no change | 0 |
| The Regents of the University of California | 2 | 100% | 100% | 100% | no change | 0 |
| Troy Holdings, Inc. | 2 | 100% | 100% | 100% | no change | 0 |
| Associated Care Ventures, Inc. | 3 | 100% | 100% | 100% | no change | 0 |
| Aultman Health Foundation | 3 | 100% | 100% | 100% | no change | 0 |
| Banner Health | 3 | 100% | 100% | 100% | no change | 0 |
| Bexar County Hospital District | 3 | 100% | 100% | 100% | no change | 0 |
| Blue Cross Blue Shield of Nebraska | 3 | 0% | none list it | 100% | no change | 0 |
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
Run it in Rivvi
Which 2027 plans near you dropped or restricted Qulipta?
Tier changes and new prior auth, step therapy or quantity limits, plan by plan, before open enrollment.
Free to start. Opens Rivvi, the AI workspace for healthcare teams.
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