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Cevimeline is a generic drug. What agents check before quoting it: how many 2027 Part D plans cover it, on which tier, with what restrictions and copays, by plan type, carrier and state.
In 2027, 2,744 of 5,492 Medicare Part D and Medicare Advantage drug plans (50%) list Cevimeline on their formulary, across 182 of 286 formularies. The most common placement is tier 4 (1,941 plans, 70.7% of those covering it). 0 of the covering plans require prior authorization (0%), 0 step therapy and 0 a quantity limit.
678 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $0, 406 of them $0; 2,066 charge coinsurance instead — median 25% of the drug's cost. Once a member's out-of-pocket drug spending reaches $2,400 in 2027, covered drugs cost $0 for the rest of the year.
2026: 2,732 of 5,496 plans covered it (49.7%); 2027: 2,744 of 5,492 (50%).
Of 4,367 plans offered in both years, 224 added it to the formulary and 90 dropped it.
Among plans covering it both years, 79 moved it to a higher tier and 209 to a lower one; 0 added prior authorization and 0 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 342 |
| Tier 2 | 316 |
| Tier 3 | 145 |
| Tier 4 | 1,941 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 37 of 323 | 11.5% | 0% |
| Medicare Advantage with drugs (MA-PD) | 1,581 of 3,200 | 49.4% | 0% |
| Special needs plans (SNP) | 1,126 of 1,969 | 57.2% | 0% |
| Carrier | Plans covering | Usual tier | Prior auth |
|---|---|---|---|
| Humana | 0 of 846 | No tier listed | 0 |
| UnitedHealthcare | 0 of 830 | No tier listed | 0 |
| Devoted Health | 446 of 728 | Tier 4 | 0 |
| Aetna Medicare | 611 of 631 | Tier 4 | 0 |
| Wellcare | 234 of 268 | Tier 1 | 0 |
| HealthSpring | 186 of 226 | Tier 4 | 0 |
| Kaiser Permanente | 0 of 112 | No tier listed | 0 |
| SCAN Health Plan | 83 of 83 | Tier 3 | 0 |
| Highmark Blue Cross Blue Shield or Highmark Blue Shield | 12 of 80 | Tier 4 | 0 |
| Alignment Health Plan | 77 of 77 | Tier 4 | 0 |
| Anthem Blue Cross and Blue Shield | 74 of 74 | Tier 4 | 0 |
| Wellpoint | 63 of 63 | Tier 4 | 0 |
| Priority Health Medicare | 40 of 40 | Tier 4 | 0 |
| CarePlus Health Plans, Inc. | 0 of 37 | No tier listed | 0 |
| Zing Health | 6 of 36 | Tier 4 | 0 |
| Capital Blue Cross | 35 of 35 | Tier 4 | 0 |
| Prominence Health Plan | 0 of 29 | No tier listed | 0 |
| Medica | 1 of 27 | Tier 4 | 0 |
| Anthem HealthKeepers | 26 of 26 | Tier 4 | 0 |
| Blue Cross Blue Shield of Michigan | 0 of 26 | No tier listed | 0 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 68 of 114 | 59.6% |
| Alaska | 1 of 9 | 11.1% |
| American Samoa | 0 of 1 | 0% |
| Arizona | 84 of 147 | 57.1% |
| Arkansas | 35 of 85 | 41.2% |
| California | 263 of 397 | 66.2% |
| Colorado | 39 of 106 | 36.8% |
| Connecticut | 28 of 54 | 51.9% |
| Delaware | 16 of 43 | 37.2% |
| District of Columbia | 2 of 12 | 16.7% |
| Florida | 283 of 545 | 51.9% |
| Georgia | 73 of 149 | 49% |
| Guam | 0 of 1 | 0% |
| Hawaii | 13 of 50 | 26% |
| Idaho | 4 of 45 | 8.9% |
| Illinois | 59 of 132 | 44.7% |
| Indiana | 60 of 138 | 43.5% |
| Iowa | 28 of 64 | 43.8% |
| Kansas | 39 of 84 | 46.4% |
| Kentucky | 50 of 121 | 41.3% |
| Louisiana | 54 of 125 | 43.2% |
| Maine | 21 of 52 | 40.4% |
| Maryland | 15 of 49 | 30.6% |
| Massachusetts | 54 of 89 | 60.7% |
| Michigan | 93 of 182 | 51.1% |
| Minnesota | 18 of 63 | 28.6% |
| Mississippi | 44 of 104 | 42.3% |
| Missouri | 87 of 170 | 51.2% |
| Montana | 1 of 27 | 3.7% |
| Nebraska | 19 of 51 | 37.3% |
| Nevada | 42 of 100 | 42% |
| New Hampshire | 4 of 25 | 16% |
| New Jersey | 33 of 73 | 45.2% |
| New Mexico | 14 of 68 | 20.6% |
| New York | 130 of 215 | 60.5% |
| North Carolina | 81 of 176 | 46% |
| North Dakota | 4 of 26 | 15.4% |
| Northern Mariana Islands | 0 of 1 | 0% |
| Ohio | 86 of 171 | 50.3% |
| Oklahoma | 23 of 81 | 28.4% |
| Oregon | 46 of 92 | 50% |
| Pennsylvania | 193 of 323 | 59.8% |
| Puerto Rico | 61 of 64 | 95.3% |
| Rhode Island | 6 of 29 | 20.7% |
| South Carolina | 41 of 89 | 46.1% |
| South Dakota | 8 of 30 | 26.7% |
| Tennessee | 93 of 156 | 59.6% |
| Texas | 227 of 407 | 55.8% |
| U.S. Virgin Islands | 0 of 1 | 0% |
| Utah | 15 of 53 | 28.3% |
| Vermont | 1 of 14 | 7.1% |
| Virginia | 42 of 144 | 29.2% |
| Washington | 41 of 114 | 36% |
| West Virginia | 34 of 69 | 49.3% |
| Wisconsin | 29 of 96 | 30.2% |
| Wyoming | 1 of 13 | 7.7% |
Medicare Part D paid for 208,529 30-day fills of Cevimeline in 2024 for about 30,180 enrollees, at an average total cost of $91.23 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Cevimeline and the rest of a client's list on every plan in their county.
Estimate Cevimeline costs by plan
Free tools for licensed insurance agents. Data from CMS public files; verify with plan documents before advising a client.
Counts are over every Medicare Advantage drug plan and stand-alone Part D plan in the CMS monthly formulary files, excluding employer plans. A plan counts as covering a drug when any strength or form of it is on the plan’s formulary; the tier, prior authorization, step therapy and quantity limit shown are the most favorable version on that formulary. Copays are for a 30-day supply at a preferred retail pharmacy after the deductible. This is a reference for licensed agents, not a plan recommendation; verify with the plan’s formulary before advising a client. Source: CMS Part D formulary files (release 10/08/2026). CMS formulary data.