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Medicare Part D
Prescription Drug Coverage 2027
Medicare Part D Formulary 2027: Drug Lists, Tiers and Changes
Reviewed by Russell Noga, Licensed Medicare Insurance Broker (all 50 states) — Last updated October 29, 2026
A Medicare Part D formulary is your plan’s list of covered drugs, and every plan has its own 2027 list. Each formulary sorts drugs into cost tiers, and 2027 lists were published on October 1, 2026, so you can check whether your medicines are covered before Annual Enrollment ends on December 7.
2027 by the Numbers
6
protected drug classes every Part D formulary must cover (CMS)
15
drugs with new Medicare-negotiated prices starting January 1, 2027 (CMS)
323
2027 standalone Part D plan filings, each with its own formulary (our count of CMS 2027 plan filings)
$35
monthly cap on covered insulin (CMS)
Two plans with the same premium can cost you very different amounts if one covers your drug on a low tier and the other puts it on a specialty tier or leaves it off entirely. That is why the formulary, not the premium, is usually the first thing to check when you compare drug coverage for 2027.
This page explains how 2027 formularies are built, what Medicare requires every plan to cover, how drug tiers affect what you pay, and how to read your plan’s list. It pairs with our Medicare Part D plans 2027 overview and the 2027 Part D deductible guide.
Key Takeaways
- Every Part D and Medicare Advantage drug plan publishes its own 2027 formulary; there is no single Medicare drug list.
- Plans must cover at least two drugs in most drug classes and nearly all drugs in six protected classes.
- Most formularies use five tiers, from preferred generics to specialty drugs, and the tier sets your copay or coinsurance.
- 15 more drugs, including Ozempic and Wegovy, carry negotiated Medicare prices from January 1, 2027.
- If your drug is not on the list, you can ask the plan for an exception.
What Is a Part D Formulary?
A formulary is the list of prescription drugs a plan agrees to pay for. Each insurer builds its own, using a pharmacy and therapeutics committee, and Medicare reviews it every year before approving the plan. The list changes from year to year, so a drug covered in 2026 is not guaranteed a spot in 2027.
What Medicare requires of every 2027 formulary
✔
At least two drugs in each commonly prescribed drug category and class, in most cases
✔
Substantially all drugs in the six protected classes: antidepressants, antipsychotics, anticonvulsants, immunosuppressants for transplants, HIV/AIDS drugs and cancer drugs
✔
The drugs that have Medicare-negotiated prices
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Covered insulin at no more than $35 for a month’s supply
✔
CDC-recommended adult vaccines at $0
Beyond those rules, plans have wide room to decide which brands they prefer, which generics they cover and how they place drugs on tiers.
How Part D Drug Tiers Work in 2027
| Tier (typical) | What it holds | What you usually pay |
|---|---|---|
| Tier 1: Preferred generic | Common low-cost generics | Lowest copay, sometimes $0 |
| Tier 2: Generic | Other generics | Low copay |
| Tier 3: Preferred brand | Brand drugs the plan favors | Mid-range copay or coinsurance |
| Tier 4: Non-preferred drug | Brands and some generics the plan does not favor | Higher coinsurance |
| Tier 5: Specialty | High-cost drugs, often over several hundred dollars a month | Coinsurance, often 25% to 33% |
Tier names and the number of tiers vary by plan. Amounts depend on the plan, pharmacy and whether you are in the deductible.
Same drug, different tier: one plan may list your blood thinner as a preferred brand while another calls it non-preferred. That single difference can change your yearly cost by hundreds of dollars, which is why plan comparisons should always use your exact drug list.
The 15 Drugs With New Negotiated Prices in 2027
Under the Medicare Drug Price Negotiation Program, 15 more drugs get Medicare-negotiated prices on January 1, 2027. Plans that cover them pay the negotiated price, which can lower your coinsurance and how fast you reach the $2,400 cap.
| Drug | Used for |
|---|---|
| Ozempic, Rybelsus, Wegovy | Type 2 diabetes, weight management |
| Trelegy Ellipta and Breo Ellipta | COPD and asthma |
| Xtandi | Prostate cancer |
| Pomalyst | Multiple myeloma |
| Ibrance | Breast cancer |
| Ofev | Lung scarring (pulmonary fibrosis) |
| Linzess | IBS with constipation |
| Calquence | Leukemia and lymphoma |
| Austedo and Austedo XR | Tardive dyskinesia, Huntington’s chorea |
| Tradjenta and Janumet | Type 2 diabetes |
| Xifaxan | IBS with diarrhea, liver disease |
| Vraylar | Schizophrenia, bipolar disorder, depression |
| Otezla | Psoriasis and psoriatic arthritis |
Source: CMS negotiated prices announced November 2025. The first 10 negotiated drugs, including Eliquis, Jardiance, Xarelto and Farxiga, have had negotiated prices since January 1, 2026.
A negotiated price does not guarantee a low copay. Your cost still depends on the tier your plan assigns the drug and on whether you have met the deductible.
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Our Count: How Many 2027 Formularies You Choose From
Our count of the CMS 2027 plan benefit filings shows 323 standalone Part D plan filings across the country’s 34 Part D regions, from 15 sponsors. Most states have between 7 and 12 standalone plans, and each one comes with its own formulary, in addition to the Medicare Advantage plans with drug coverage in your county. Our compare Part D plans by state 2027 table lists the companies in each state.
102
Humana standalone PDP filings for 2027
73
UnitedHealthcare filings
40
HealthSpring filings
20
Aetna SilverScript filings
What that means: the same company often runs one formulary across its plans and changes the tier placement or deductible between them. Comparing two plans from one company can still turn up a different cost for the same drug.
Can a Plan Change Its Formulary During 2027?
Formularies are mostly set for the year, but plans can make some changes after January 1. They can add drugs at any time. They can replace a brand with a new generic or biosimilar, and they can remove a drug the FDA says is unsafe. For other changes that hurt current users, the plan generally must give at least 30 days’ notice or a refill of the drug.
Protections if your drug changes
✔
A written notice explaining the change and your options
✔
A transition supply, usually up to 30 days, when you are new to a plan and your drug is not on its list
✔
The right to request a formulary or tier exception
✔
The right to switch plans during a Special Enrollment Period if you qualify
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What to Do If Your Drug Is Not Covered
1
Ask about a covered alternative. Your doctor may be able to switch you to a similar drug on the plan’s formulary.
2
Request a coverage determination. You or your doctor can ask the plan to cover the drug as a formulary exception, or to charge a lower tier price as a tiering exception.
3
Include a supporting statement. Your prescriber explains why the covered alternatives would not work for you.
4
Watch the clock. The plan must decide within 72 hours, or 24 hours for an expedited request when waiting could harm your health.
5
Appeal if denied. You can appeal to the plan and then to an independent review entity.
How to Check a Plan's 2027 Formulary
1
Read your Annual Notice of Change. It lists drugs your current plan is dropping or moving to a different tier in 2027.
2
Search Medicare Plan Finder. Enter each drug and dose; it shows whether each 2027 plan covers it, the tier and any prior authorization, step therapy or quantity limits.
3
Download the plan’s formulary. Every plan posts its full 2027 drug list on its website.
4
Confirm your pharmacy. Preferred pharmacies can cut copays on the same tier.
Before December 7: if your plan dropped a drug or moved it up a tier for 2027, Annual Enrollment is your chance to switch to a plan that covers it at a lower cost. Not every plan covers every drug, and plans vary by area.
Then compare deductibles with our Part D deductible 2027 guide before the Part D open enrollment 2027 deadline.
The Bottom Line
The Bottom Line
Every 2027 Part D plan has its own formulary, and the tier your drug lands on drives what you pay. Check your Annual Notice of Change and search your drugs in Plan Finder before December 7, 2026, especially if you take one of the 15 newly negotiated drugs.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048) to get information on all of your options.
Frequently Asked Questions
➤ What is a Medicare Part D formulary?
It is a plan’s list of covered prescription drugs, grouped into cost tiers. Each Part D plan and Medicare Advantage drug plan has its own formulary.
➤ When are 2027 Part D formularies available?
Plan-level 2027 information, including formularies, has been available on Medicare Plan Finder since October 1, 2026. Plans also post their drug lists online.
➤ How many tiers does a Part D formulary have?
Most plans use five tiers: preferred generic, generic, preferred brand, non-preferred drug and specialty. Some plans use fewer or more.
➤ Do all Part D plans cover the same drugs?
No. Plans must meet Medicare’s minimum rules, such as covering the protected classes, but each chooses its own list and tiers.
➤ Which drugs get negotiated prices in 2027?
Fifteen drugs, including Ozempic, Rybelsus, Wegovy, Trelegy Ellipta, Xtandi, Ibrance and Linzess, get negotiated Medicare prices starting January 1, 2027.
➤ Can my plan drop my drug in the middle of the year?
In limited cases. Plans can make some mid-year changes but usually must give current users at least 30 days’ notice or a refill, and you can request an exception.
➤ What is a formulary exception?
It is a request asking your plan to cover a drug that is not on its formulary. Your prescriber supports it with a statement, and the plan must answer within 72 hours.
➤ What is a tiering exception?
It is a request to pay the cost of a lower tier for a drug, usually because the cheaper alternatives would not work for you. Specialty-tier drugs are often not eligible.
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