Medicare drug coverage

Ultomiris: 2027 Medicare Part D coverage

No 2027 formulary row matched the RxNorm products for Ultomiris across 5,495 Part D plans. A missing row can be a product the file codes another way, so this is a lookup result, not proof that plans dropped it.

License. US government work, Public Domain Mark 1.0.

2027 compared with 2026

Ultomiris is number 173 by total Medicare Part D spending in 2024 ($233 million). Counts use 4 RxNorm products for this name.

Ultomiris Part D coverage, 2026 and 2027
Measure20262027Change
Part D plans in the file5,5185,495-23
Plans that list it0 (0%)0 (0%)no change
Prior authorization (of plans that list it)00no change
Step therapy (of plans that list it)00no change
Quantity limit (of plans that list it)00no change
Any of the three (of plans that list it)00no 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

No plan lists Ultomiris in either year, so there is no tier to show.

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 Ultomiris, and 0 stopped listing it.

Ultomiris: plans in both 2026 and 2027
Plan by planPlans
Same plan id in both years4,380
Listed it in 2026, not in 20270 (0%)
Listed it in 2027, not in 20260 (0%)
Moved it to a higher tier0 (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 Ultomiris off the formulary or list it with prior authorization, step therapy, or a quantity limit. Alaska ranks first at 100%, with 0% 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 Ultomiris, 2027
RankState2027 plansNot listed or restrictedPrior auth or step therapyChange from 2026
1Alaska9100%0%no change
2Alabama115100%0%no change
3Arkansas86100%0%no change
4Arizona148100%0%no change
5California397100%0%no change
6Colorado106100%0%no change
7Connecticut54100%0%no change
8District of Columbia21100%0%no change
9Delaware43100%0%no change
10Florida549100%0%no change
11Georgia151100%0%no change
12Hawaii50100%0%no change
13Iowa64100%0%no change
14Idaho45100%0%no change
15Illinois133100%0%no change
16Indiana140100%0%no change
17Kansas84100%0%no change
18Kentucky123100%0%no change
19Louisiana126100%0%no change
20Massachusetts92100%0%no change
21Maryland49100%0%no change
22Maine52100%0%no change
23Michigan183100%0%no change
24Minnesota63100%0%no change
25Missouri171100%0%no change
26Mississippi105100%0%no change
27Montana27100%0%no change
28North Carolina177100%0%no change
29North Dakota26100%0%no change
30Nebraska51100%0%no change
31New Hampshire25100%0%no change
32New Jersey74100%0%no change
33New Mexico68100%0%no change
34Nevada100100%0%no change
35New York215100%0%no change
36Ohio173100%0%no change
37Oklahoma81100%0%no change
38Oregon92100%0%no change
39Pennsylvania324100%0%no change
40Rhode Island29100%0%no change
41South Carolina91100%0%no change
42South Dakota30100%0%no change
43Tennessee157100%0%no change
44Texas412100%0%no change
45Utah53100%0%no change
46Virginia145100%0%no change
47Vermont14100%0%no change
48Washington114100%0%no change
49Wisconsin97100%0%no change
50West Virginia70100%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 Ultomiris off or restrict it.

Ultomiris coverage by parent organization, 2027
Parent organization2027 plans ↑List itRestrict it (of listing)Not listed or restrictedChange from 2026Plans that added a restriction
BrightSpring Health Services, Inc.20%none list it100%no change0
Community Health Group20%none list it100%no change0
Community Health Plan of Washington20%none list it100%no change0
Denver Health and Hospital Authority20%none list it100%no change0
Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT20%none list it100%no change0
Elite Health Systems, Inc.20%none list it100%no change0
Group Health Cooperative of Eau Claire20%none list it100%no change0
Hamaspik of Rockland County, Inc.20%none list it100%no change0
ISNP Holdings, LLC20%none list it100%no change0
Kansas Superior Select20%none list it100%no change0
Missouri Healthcare Advisors, LLC20%none list it100%no change0
MultiCare Health Systems20%none list it100%new in 20270
NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND20%none list it100%no change0
PrimeWest Rural MN Health Care Access Initiative20%none list it100%no change0
Regency ISNP Holdings LLC20%none list it100%no change0
Select Founders, LLC20%none list it100%no change0
Sentara Health Care (SHC)20%none list it100%no change0
South Country Health Alliance20%none list it100%no change0
The Regents of the University of California20%none list it100%no change0
Troy Holdings, Inc.20%none list it100%no change0
Associated Care Ventures, Inc.30%none list it100%no change0
Aultman Health Foundation30%none list it100%no change0
Banner Health30%none list it100%no change0
Bexar County Hospital District30%none list it100%no change0
Blue Cross Blue Shield of Nebraska30%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

Run it in Rivvi

Which 2027 plans near you dropped or restricted Ultomiris?

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

Try it on your own data today.

Free to start. Most teams are using it the same day.

Get started for freeSee pricing