Medicare drug coverage

Xtampza: 2027 Medicare Part D coverage

957 of 5,495 Part D plans (17%) list Xtampza on their 2027 formulary, the plan's list of covered drugs (down 1 point from 2026). 89% 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

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 (a tier is the cost level a plan puts a drug on; a lower tier usually costs less). 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%)-1 point
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

For pharmacies and agencies: check a whole drug list against 2027 formularies.

Upload your patient list or your book of clients and Rivvi checks each drug against the CMS 2027 formulary files, plan by plan, so you see tier changes and new limits before the next refill or open enrollment. Free to start. HIPAA BAA included.

For pharmaciesFor agencies

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. 29 states tie for the highest share, 100%; North Dakota ranks last at 85%. 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 Xtampza, 2027
RankState2027 plansNot listed or restrictedPrior auth or step therapyChange from 2026
1Rhode Island29100%17%no change
Tied 2Alaska9100%0%no change
Tied 2Alabama115100%0%no change
Tied 2Arkansas86100%0%no change
Tied 2California397100%0%no change
Tied 2Colorado106100%0%no change
Tied 2Connecticut54100%0%no change
Tied 2District of Columbia21100%0%no change
Tied 2Idaho45100%0%no change
Tied 2Kansas84100%0%no change
Tied 2Kentucky123100%0%+1 point
Tied 2Maryland49100%0%+5 points
Tied 2Maine52100%0%no change
Tied 2Mississippi105100%0%no change
Tied 2Montana27100%0%no change
Tied 2New Hampshire25100%0%no change
Tied 2New Mexico68100%0%no change
Tied 2Nevada100100%0%+5 points
Tied 2New York215100%0%no change
Tied 2Ohio173100%0%no change
Tied 2Oklahoma81100%0%no change
Tied 2Tennessee157100%0%no change
Tied 2Utah53100%0%no change
Tied 2Virginia145100%0%no change
Tied 2Vermont14100%0%no change
Tied 2Washington114100%0%no change
Tied 2West Virginia70100%0%no change
Tied 2Wyoming13100%0%no change
Tied 2Florida549100%0%+3 points
Tied 30Illinois13399%0%no change
Tied 30Louisiana12699%0%-1 point
Tied 30Texas41299%0%no change
Tied 30Oregon9299%0%no change
Tied 30Michigan18399%0%-1 point
Tied 35Missouri17198%0%no change
Tied 35Pennsylvania32498%0%-1 point
Tied 35Georgia15198%0%-2 points
Tied 35Hawaii5098%0%+2 points
Tied 35Indiana14098%0%no change
40Massachusetts9297%0%no change
41Delaware4395%0%-5 points
42Arizona14894%0%-2 points
43Nebraska5192%0%-1 point
44New Jersey7491%0%-9 points
Tied 45South Carolina9190%0%-2 points
Tied 45North Carolina17790%0%-6 points
47Iowa6488%0%no change
Tied 48Minnesota6387%0%-6 points
Tied 48South 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
CoxHealth30%none list it100%no change0
First Sacramento Capital Funding LLC30%none list it100%no change0
Imperial Health Plan of California30%none list it100%no change0
Liberty Healthcare Insurance30%none list it100%no change0
Marquis Companies I, Inc.30%none list it100%no change0
McLaren Health Care Corporation30%none list it100%no change0
MedCare Partners Holding, LLC30%none list it100%new in 20270
Mercy Care30%none list it100%no change0
New York City Health and Hospitals Corporation30%none list it100%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 Inc40%none list it100%no change0
Chinese Hospital Association40%none list it100%no change0
El Paso County Hospital District40%none list it100%no change0
Elderplan, Inc.40%none list it100%no change0
Horizon Mutual Holdings, Inc40%none list it100%no change0
LMC Family Holdings, LLC40%none list it100%no change0
Montage Health40%none list it100%no change0
St Francis Health System & St John Health System40%none list it100%no change0
Blue Cross & Blue Shield of Rhode Island5100%100%100%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

Try it on your own data today.

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

Get started for freeSee pricing