Medicare drug coverage

Velphoro: 2027 Medicare Part D coverage

322 of 5,495 Part D plans (6%) list Velphoro on their 2027 formulary, up 1 point from 2026. 12% of those require prior authorization, step therapy, or a quantity limit.

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2027 compared with 2026

Velphoro is number 103 by total Medicare Part D spending in 2024 ($438 million). Plans that list it most often put it on tier 5. Counts use 2 RxNorm products for this name.

Velphoro Part D coverage, 2026 and 2027
Measure20262027Change
Part D plans in the file5,5185,495-23
Plans that list it281 (5%)322 (6%)+1 point
Prior authorization (of plans that list it)15 (5%)40 (12%)+7 points
Step therapy (of plans that list it)0 (0%)0 (0%)no change
Quantity limit (of plans that list it)15 (5%)19 (6%)+1 point
Any of the three (of plans that list it)15 (5%)40 (12%)+7 points
Not listed or restricted (of all plans)5,252 (95%)5,213 (95%)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

Velphoro formulary tier, 2026 and 2027
Tier2026 plans2027 plans
Tier 122 (8%)19 (6%)
Tier 326 (9%)29 (9%)
Tier 5233 (83%)274 (85%)

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 Velphoro, and 4 stopped listing it.

Velphoro: plans in both 2026 and 2027
Plan by planPlans
Same plan id in both years4,380
Listed it in 2026, not in 20274 (0%)
Listed it in 2027, not in 202653 (1%)
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 Velphoro off the formulary or list it with prior authorization, step therapy, or a quantity limit. New York ranks first at 100%, with 10% of its plans using prior authorization or step therapy; Massachusetts ranks last at 72%. Ties break on the prior authorization or step therapy share.

States from most to least restrictive for Velphoro, 2027
RankState2027 plansNot listed or restrictedPrior auth or step therapyChange from 2026
1New York215100%10%no change
2Utah53100%6%no change
3Mississippi105100%4%no change
4Arkansas86100%3%no change
5Alaska9100%0%no change
6Alabama115100%0%no change
7Connecticut54100%0%+4 points
8Idaho45100%0%no change
9Kansas84100%0%no change
10Kentucky123100%0%+1 point
11Maine52100%0%no change
12Montana27100%0%no change
13New Hampshire25100%0%no change
14New Mexico68100%0%no change
15Oklahoma81100%0%no change
16Rhode Island29100%0%no change
17Tennessee157100%0%no change
18Vermont14100%0%no change
19West Virginia70100%0%no change
20Wyoming13100%0%no change
21Illinois13399%0%no change
22Louisiana12699%0%-1 point
23Michigan18399%0%-1 point
24Ohio17398%0%no change
25Missouri17198%0%no change
26Pennsylvania32498%0%-1 point
27Indiana14098%0%no change
28Texas41296%0%no change
29Virginia14596%0%no change
30Oregon9296%0%+1 point
31Florida54996%0%-1 point
32Delaware4395%0%-5 points
33Arizona14895%0%no change
34Georgia15193%0%-2 points
35Nebraska5192%0%-1 point
36North Carolina17791%0%-5 points
37New Jersey7491%0%-9 points
38South Carolina9190%0%-3 points
39Colorado10690%4%+3 points
40California39788%0%no change
41Iowa6488%0%no change
42Minnesota6387%0%-5 points
43Nevada10087%3%no change
44South Dakota3087%0%no change
45Hawaii5086%0%+3 points
46Washington11486%0%+1 point
47District of Columbia2186%0%-2 points
48Wisconsin9786%0%no change
49North Dakota2685%0%no change
50Maryland4980%0%no change
51Massachusetts9272%0%-2 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 Velphoro off or restrict it.

Velphoro 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%0%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 Corporation2680%none list it100%no change0
Health Care Service Corporation2310%none list it100%no change0
Kaiser Foundation Health Plan, Inc.112100%0%0%no change0
Highmark Health980%none list it100%no change0
SCAN Group850%none list it100%no change0
Alignment Healthcare USA, LLC770%none list it100%no change0
Guidewell Mutual Holding Corporation550%none list it100%no change0
Blue Cross Blue Shield of Michigan Mutual Ins. Co.430%none list it100%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 CROSS350%none list it100%no change0
Medica Holding Company310%none list it100%no change0
UPMC Health System300%none list it100%no change0
Universal Health Services, Inc.29100%0%0%no change0
MHH Healthcare, L.P.260%none list it100%no change0
Independence Health Group, Inc.2544%0%56%-44 points0
Point32Health, Inc.23100%0%0%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

Run it in Rivvi

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Tier changes and new prior auth, step therapy or quantity limits, plan by plan, before open enrollment.

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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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