Medicare drug coverage

Xtampza: 2027 Medicare Part D coverage

957 of 5,495 Part D plans (17%) list Xtampza on their 2027 formulary, the same share as 2026. 89% of those require prior authorization, step therapy, or a quantity limit.

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2027 compared with 2026

Xtampza is number 174 by total Medicare Part D spending in 2024 ($233 million). Plans that list it most often put it on tier 4. Counts use 6 RxNorm products for this name.

Xtampza Part D coverage, 2026 and 2027
Measure20262027Change
Part D plans in the file5,5185,495-23
Plans that list it985 (18%)957 (17%)no change
Prior authorization (of plans that list it)37 (4%)5 (1%)-3 points
Step therapy (of plans that list it)0 (0%)0 (0%)no change
Quantity limit (of plans that list it)887 (90%)853 (89%)-1 point
Any of the three (of plans that list it)887 (90%)853 (89%)-1 point
Not listed or restricted (of all plans)5,420 (98%)5,391 (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

Xtampza formulary tier, 2026 and 2027
Tier2026 plans2027 plans
Tier 118 (2%)15 (2%)
Tier 3116 (12%)94 (10%)
Tier 4851 (86%)848 (89%)

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 Xtampza, and 38 stopped listing it.

Xtampza: plans in both 2026 and 2027
Plan by planPlans
Same plan id in both years4,380
Listed it in 2026, not in 202738 (1%)
Listed it in 2027, not in 202639 (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 Xtampza off the formulary or list it with prior authorization, step therapy, or a quantity limit. Rhode Island ranks first at 100%, with 17% of its plans using prior authorization or step therapy; North Dakota ranks last at 85%. Ties break on the prior authorization or step therapy share.

States from most to least restrictive for Xtampza, 2027
RankState2027 plansNot listed or restrictedPrior auth or step therapyChange from 2026
1Rhode Island29100%17%no change
2Alaska9100%0%no change
3Alabama115100%0%no change
4Arkansas86100%0%no change
5California397100%0%no change
6Colorado106100%0%no change
7Connecticut54100%0%no change
8District of Columbia21100%0%no change
9Idaho45100%0%no change
10Kansas84100%0%no change
11Kentucky123100%0%+1 point
12Maryland49100%0%+5 points
13Maine52100%0%no change
14Mississippi105100%0%no change
15Montana27100%0%no change
16New Hampshire25100%0%no change
17New Mexico68100%0%no change
18Nevada100100%0%+5 points
19New York215100%0%no change
20Ohio173100%0%no change
21Oklahoma81100%0%no change
22Tennessee157100%0%no change
23Utah53100%0%no change
24Virginia145100%0%no change
25Vermont14100%0%no change
26Washington114100%0%no change
27West Virginia70100%0%no change
28Wyoming13100%0%no change
29Florida549100%0%+2 points
30Illinois13399%0%no change
31Louisiana12699%0%-1 point
32Texas41299%0%no change
33Oregon9299%0%no change
34Michigan18399%0%-1 point
35Missouri17198%0%no change
36Pennsylvania32498%0%-1 point
37Georgia15198%0%-2 points
38Hawaii5098%0%+2 points
39Indiana14098%0%no change
40Massachusetts9297%0%no change
41Delaware4395%0%-5 points
42Arizona14894%0%-2 points
43Nebraska5192%0%-1 point
44New Jersey7491%0%-9 points
45South Carolina9190%0%-2 points
46North Carolina17790%0%-6 points
47Iowa6488%0%no change
48Minnesota6387%0%-5 points
49South Dakota3087%0%no change
50Wisconsin9786%0%no change
51North Dakota2685%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 Xtampza off or restrict it.

Xtampza 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.850100%100%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.1120%none list it100%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.290%none list it100%no change0
MHH Healthcare, L.P.260%none list it100%no change0
Independence Health Group, Inc.2544%0%56%-44 points0
Point32Health, Inc.230%none list it100%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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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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