2027 Part D Formularies: Is Your Drug Still Covered?
Every Medicare drug plan publishes a new drug list for 2027. Most common drugs stayed put, but thousands of plan listings moved a drug to a higher tier or added prior authorization. Here is what changed and how to check yours before December 7.
Key takeaways
- Across 4,748 renewing Medicare drug plans and the 100 most-prescribed Part D drugs, 90.6% of plan and drug pairs kept the same tier for 2027.
- The rest moved: 2.0% went to a higher, usually costlier tier, 7.4% went to a lower tier, and 354 pairs were dropped from the drug list.
- Plans added prior authorization to 10,622 plan and drug pairs and step therapy to 2,382, so a drug can stay covered and still be harder to get.
- The Part D out-of-pocket cap rises to $2,400 in 2027 (from $2,100), and the standard deductible to $700, per the CMS CY2027 Rate Announcement.
- If your drug changed, you can switch plans during Annual Enrollment, October 15 to December 7, 2026, or ask your plan for an exception.
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Probably, but check: for 2027 most common drugs kept their place on Medicare drug lists, and a meaningful minority did not. A formulary is your plan's list of covered drugs, sorted into price tiers. Every Medicare Part D plan and every Medicare Advantage plan with drug coverage publishes a new one each year, and the 2027 lists take effect January 1.
To see how much changed, we looked at a national comparison built from the CMS formulary files: the 100 drugs with the most Part D claims in 2024, followed in each of 4,748 plans from its 2026 drug list to the plan that replaces it in 2027 under the CMS plan crosswalk. That is 474,300 plan and drug pairs. A plan and drug pair is simply one drug in one plan: Eliquis in one plan is one pair, Eliquis in another plan is a second pair.
Below: what moved, which well-known drugs were affected, what the 2027 Part D numbers mean for your costs, and what to do if your drug is no longer covered the way it was. We speak insurance, so you don't have to.
What is a Part D formulary, and why does it change every year?
A formulary is the list of prescription drugs a plan covers. Each drug sits on a tier, and the tier sets your copay or coinsurance: low tiers are usually preferred generics, higher tiers are brand and specialty drugs that cost you more. Plans may change the list and the tiers every year, and the new list takes effect January 1.
Federal rules set the floor. Under 42 CFR 423.120, every formulary must include at least two drugs in each therapeutic category and class (one where only one exists). Plans must also cover most drugs in six protected classes: cancer drugs, HIV and AIDS drugs, antidepressants, antipsychotics, anticonvulsants and immunosuppressants for organ transplants, as Medicare.gov explains.
How much did Medicare drug lists change for 2027?
Most pairs did not change: 90.6% of the 474,300 plan and drug pairs kept the same tier. Moves down outnumbered moves up, 34,904 to 9,278. Only 354 pairs, 0.1%, dropped a drug from the list entirely.
- of plan and drug pairs kept the same tier
- 90.6%
- moved to a higher tier
- 2.0%
- moved to a lower tier
- 7.4%
- pairs newly requiring prior authorization
- 10,622
| Change | Plan and drug pairs | Share |
|---|---|---|
| Same tier | 429,764 | 90.6% |
| Moved to a lower tier | 34,904 | 7.4% |
| Moved to a higher tier | 9,278 | 2.0% |
| Dropped from the drug list | 354 | 0.1% |
| Prior authorization newly required | 10,622 | 2.2% |
| Step therapy newly required | 2,382 | 0.5% |
Small percentages still add up. A 2% share of moves to a higher tier is more than 9,000 cases where a member keeps the same drug and pays more for it in 2027. The only way to know whether you are one of them is to look up your own drugs in your own plan's 2027 list.
Which common drugs moved to a higher tier or picked up new rules?
Among the 100 most-prescribed drugs, a handful changed in far more plans than the rest. Three widely used benzodiazepines (clonazepam, lorazepam and alprazolam) led the list, followed by Xarelto, a blood thinner, and Mounjaro, a diabetes drug. Triamcinolone, a steroid used in creams and nasal sprays, also moved up a tier in about one plan in twenty.
| Drug | Plans compared | Moved to a higher tier | Dropped from the list | Plans adding prior authorization |
|---|---|---|---|---|
| Clonazepam | 4,748 | 19.2% | 0.0% | 887 |
| Lorazepam | 4,748 | 19.2% | 0.0% | 1,187 |
| Alprazolam | 4,686 | 3.5% | 6.9% | 209 |
| Xarelto | 4,748 | 7.8% | 0.0% | 14 |
| Mounjaro | 4,616 | 7.2% | 0.3% | 1 |
| Triamcinolone Acetonide | 4,748 | 5.3% | 0.0% | 0 |
Two of these are worth a closer look. Xarelto moved to a higher tier in 7.8% of plans; it is also one of the drugs CMS removed from the Medicare drug price negotiation program as of January 1, 2027. Mounjaro moved up in 7.2% of the 4,616 plans that carried it. If you take either one, check your 2027 tier before you renew.
Which drugs got easier to afford?
Some drugs moved down a tier in many plans, which usually lowers the copay in that plan. Farxiga moved to a lower tier in 49.9% of plans, the largest shift among the 100 drugs, while 1,613 plans added step therapy to it. That is a reminder that one drug can get cheaper and harder to get in the same year.
Source: Rise Up Benefits Group Data Desk analysis of the CMS CY2026 and CY2027 Part D formulary files, each plan followed to its 2027 successor in the CMS 2027 plan crosswalk, for the 100 drugs with the most 2024 Part D claims (CMS Part D Spending by Drug). Retrieved October 26, 2026.
Other common brand drugs mostly held steady. Jardiance moved down in 6.7% of plans and up in 1.2%, but 862 plans added prior authorization to it. Januvia shows the same pattern: down in 7.3% of plans, with 831 plans adding prior authorization.
What do the 2027 Part D numbers mean for my costs?
The formulary decides your tier; the federal benefit decides the limits. For 2027 the standard deductible is $700 (up from $615) and the yearly out-of-pocket cap is $2,400 (up from $2,100), both from the CMS CY2027 Rate Announcement, Attachment V. After the cap you pay $0 for covered drugs for the rest of the year.
| 2026 | 2027 | |
|---|---|---|
| Deductible, at most | $615 | $700 |
| Your share in initial coverage (standard plan) | 25% | 25% |
| Yearly out-of-pocket cap | $2,100 | $2,400 |
| After the cap | $0 for covered drugs | $0 for covered drugs |
If you get Extra Help, a tier move matters less: in 2027 you pay at most $5.80 for a generic and $14.40 for a brand-name drug on your plan's list (CMS CY2027 Rate Announcement, Table V-2), whatever its tier. A drug that leaves the list still needs an exception or a switch.
The cap only protects drugs on your plan's list. A drug that falls off the formulary does not count toward it unless you win an exception, which is why the drug list matters more than the cap. Our answer page explains how the 2027 cap works with examples.
Which drugs have negotiated Medicare prices starting in 2027?
Fifteen drugs get Medicare negotiated prices starting January 1, 2027, the second round of the Medicare drug price negotiation program. The negotiated price is what the plan pays; what you pay still depends on your plan's tier and the benefit stage you are in.
| Drug | Negotiated price | 2024 list price |
|---|---|---|
| Ozempic, Rybelsus, Wegovy | $274 | $959 |
| Trelegy Ellipta | $175 | $654 |
| Breo Ellipta | $67 | $397 |
| Linzess | $136 | $539 |
| Tradjenta | $78 | $488 |
| Janumet, Janumet XR | $80 | $526 |
| Xifaxan | $1,000 | $2,696 |
| Vraylar | $770 | $1,376 |
Some drugs are leaving the program. CMS lists Stelara, Entresto, Xarelto, NovoLog and Fiasp as removed effective January 1, 2027, on its selected drugs page. A drug leaving the program is not the same as leaving your formulary, but it is a reason to check its 2027 tier.
How do I check whether my drug is still covered in 2027?
- Read your Annual Notice of Change. Plans must send it so you receive it by September 30 (42 CFR 423.2267(e)(3)). It lists drug list changes that start January 1.
- Look up each drug in the 2027 formulary, not this year's. Use the exact name and dose.
- Note the tier and any rule: prior authorization, step therapy or a quantity limit.
- Check your pharmacy. A preferred pharmacy can cut the copay on the same tier.
- Have us compare the other plans we offer in your county against the same list before December 7.
In a review with Viola, we start from your pill bottles, not the plan brochure: the exact name, strength and how often each one is filled, plus the pharmacy you actually use. We look up each drug in the 2027 list of your current plan and of the other plans we offer in your county, and anything that moved tier or picked up prior authorization goes on a short list we talk through with you.
Our annual Medicare review checklist covers the rest of your Annual Notice of Change, and our guide shows how to check doctors and drugs step by step.
What if my drug is no longer covered the same way?
You have three paths: switch plans during Annual Enrollment, ask your plan for an exception, or move to a covered alternative with your doctor. Annual Enrollment runs October 15 to December 7, 2026, and is the simplest fix when another plan covers your drug well.
Ask for an exception
- Your doctor sends a supporting statement explaining why you need the drug
- The plan decides within 72 hours, or 24 hours when waiting could harm your health (42 CFR 423.568 and 423.572)
- You can appeal a denial
Use the transition fill
- If you stay in a plan whose formulary changed, the plan must give a temporary month's supply within the first 90 days of 2027 (42 CFR 423.120(b)(3))
- It buys time for an exception or a switch, not a permanent fix
- The plan must send you a written notice within 3 business days
During the year, plans can still make some changes. They must tell affected members at least 30 days before a negative change, or give a month's supply when you ask for a refill (42 CFR 423.120(f)). And no negative change can take effect from the start of Annual Enrollment until 60 days into the plan year (42 CFR 423.120(e)(4)).
What should I watch for in 2027?
- CMS publishes the 2027 Part B premium and deductible around mid-November 2026; we update our pages the day it does.
- The 2027 Extra Help income and resource limits are still pending; the 2026 limits apply until CMS updates them.
- Plans can still make midyear formulary changes with notice, so read every letter from your plan in 2027.
- Drugs leaving the negotiation program on January 1 (Stelara, Entresto, Xarelto, NovoLog, Fiasp) may change price within plans.
- The Medicare Prescription Payment Plan lets you spread drug costs across the year; ask about it if January bills worry you.
The bottom line
For 2027, 90.6% of drug and plan pairs among the most-prescribed Part D drugs kept their tier, but thousands moved up, picked up prior authorization or left a drug list. Look up every drug in your plan's 2027 formulary before December 7, and if one changed, switch plans or ask for an exception. The $2,400 cap protects you only for drugs your plan covers.
Frequently asked questions
How do I know if my drug is covered by my Medicare plan in 2027?
Look it up in your plan's 2027 formulary, using the exact drug name and dose, and check the tier and any prior authorization or step therapy rule. Your Annual Notice of Change lists the changes. We can look up every drug on your list against your plan and two or three others in one appointment.
Can a Medicare drug plan drop my drug in the middle of the year?
Yes, in limited cases. The plan must give affected members written notice at least 30 days before the change, or a month's supply when they ask for a refill. A drug the FDA withdraws for safety, or a direct generic replacement, can be changed sooner with notice afterward. If it happens to you, we help you ask for an exception or find a plan that covers it.
What is a transition fill?
It is a temporary supply, at least a month's worth, that your plan must give you within the first 90 days of the year if your drug is no longer covered the way it was. It buys time to get an exception or switch drugs with your doctor. It is not a permanent fix, so call us as soon as the temporary supply arrives and we help you plan the next step.
How long does a Part D formulary exception take?
Once the plan has your doctor's supporting statement, it must decide within 72 hours, or within 24 hours if waiting could seriously harm your health. If the plan says no, you can appeal. We help you gather what the plan asks for so the request is complete the first time.
Does the $2,400 cap cover drugs that are not on my plan's list?
No. The $2,400 cap for 2027 counts only what you pay for covered drugs. A drug off your plan's formulary does not count unless the plan grants an exception. That is why checking the 2027 drug list matters more than the cap itself.
Is a lower tier always cheaper?
Within one plan, usually yes. Between plans, not necessarily: tier 2 in one plan can cost more than tier 3 in another, and preferred pharmacies change the price too. Compare the yearly cost for your exact drugs in each plan rather than tier numbers; we run that comparison for you in a review.
What if my drug moved to a higher tier for 2027?
You have three options: switch plans by December 7, ask your plan for a tiering exception with your doctor's support, or ask your doctor about a lower-tier alternative. Which one is best depends on the drug and your other prescriptions, and that is exactly what we check in a review.
Why work with an agent to check my 2027 drug coverage?
Because the answer depends on every drug you take, at every dose, at the pharmacy you use, across the plans we represent in your county. We do that comparison for you, explain what you have, how to use it and what it covers, and handle the enrollment if a change makes sense, with no cost to you for our help.
Sources
- CMS Monthly Prescription Drug Plan Formulary and Pharmacy Network Information (CY2026 and CY2027 formulary files) Centers for Medicare & Medicaid Services
- CMS Medicare Advantage and Part D plan crosswalks, 2027 Centers for Medicare & Medicaid Services
- CMS Medicare Part D Spending by Drug Centers for Medicare & Medicaid Services
- CMS CY2027 Rate Announcement, Attachment V Centers for Medicare & Medicaid Services
- CMS fact sheet: negotiated prices for initial price applicability year 2027 Centers for Medicare & Medicaid Services
- CMS CY2026 Rate Announcement, Attachment V Centers for Medicare & Medicaid Services
- CMS: Selected drugs and negotiated prices (drugs with deselection determinations) Centers for Medicare & Medicaid Services
- 42 CFR 423.120, formulary requirements and transition process Electronic Code of Federal Regulations
- 42 CFR 423.568, standard timeframes for coverage determinations Electronic Code of Federal Regulations
- Medicare.gov: How Medicare drug plans work Centers for Medicare & Medicaid Services
Please note: We do not offer every plan available in your area. Currently we represent 34 organizations which offer 64 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.Rise Up Benefits Group is not connected with or endorsed by the United States government or the federal Medicare program. Medicare has neither endorsed nor reviewed this information. This article is general information, not medical, tax or legal advice.
