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Esomeprazole 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, 5,125 of 5,492 Medicare Part D and Medicare Advantage drug plans (93.3%) list Esomeprazole on their formulary, across 268 of 286 formularies. The most common placement is tier 3 (2,969 plans, 57.9% of those covering it). 0 of the covering plans require prior authorization (0%), 914 step therapy and 4,689 a quantity limit.
1,986 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $0, 1,091 of them $0; 3,139 charge coinsurance instead — median 22% 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: 5,199 of 5,496 plans covered it (94.6%); 2027: 5,125 of 5,492 (93.3%).
Of 4,367 plans offered in both years, 9 added it to the formulary and 79 dropped it.
Among plans covering it both years, 142 moved it to a higher tier and 561 to a lower one; 0 added prior authorization and 0 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 296 |
| Tier 2 | 1,729 |
| Tier 3 | 2,969 |
| Tier 4 | 131 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 193 of 323 | 59.8% | 0% |
| Medicare Advantage with drugs (MA-PD) | 3,003 of 3,200 | 93.8% | 0% |
| Special needs plans (SNP) | 1,929 of 1,969 | 98% | 0% |
| Carrier | Plans covering | Usual tier | Prior auth |
|---|---|---|---|
| Humana | 812 of 846 | Tier 3 | 0 |
| UnitedHealthcare | 796 of 830 | Tier 3 | 0 |
| Devoted Health | 728 of 728 | Tier 2 | 0 |
| Aetna Medicare | 611 of 631 | Tier 2 | 0 |
| Wellcare | 268 of 268 | Tier 3 | 0 |
| HealthSpring | 191 of 226 | Tier 3 | 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 2 | 0 |
| Alignment Health Plan | 77 of 77 | Tier 2 | 0 |
| Anthem Blue Cross and Blue Shield | 74 of 74 | Tier 3 | 0 |
| Wellpoint | 63 of 63 | Tier 3 | 0 |
| Priority Health Medicare | 40 of 40 | Tier 4 | 0 |
| CarePlus Health Plans, Inc. | 37 of 37 | Tier 3 | 0 |
| Zing Health | 36 of 36 | Tier 2 | 0 |
| Capital Blue Cross | 35 of 35 | Tier 2 | 0 |
| Prominence Health Plan | 29 of 29 | Tier 2 | 0 |
| Medica | 27 of 27 | Tier 3 | 0 |
| Anthem HealthKeepers | 26 of 26 | Tier 3 | 0 |
| Blue Cross Blue Shield of Michigan | 26 of 26 | Tier 2 | 0 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 109 of 114 | 95.6% |
| Alaska | 5 of 9 | 55.6% |
| American Samoa | 1 of 1 | 100% |
| Arizona | 143 of 147 | 97.3% |
| Arkansas | 80 of 85 | 94.1% |
| California | 345 of 397 | 86.9% |
| Colorado | 92 of 106 | 86.8% |
| Connecticut | 50 of 54 | 92.6% |
| Delaware | 34 of 43 | 79.1% |
| District of Columbia | 9 of 12 | 75% |
| Florida | 511 of 545 | 93.8% |
| Georgia | 137 of 149 | 91.9% |
| Guam | 1 of 1 | 100% |
| Hawaii | 41 of 50 | 82% |
| Idaho | 34 of 45 | 75.6% |
| Illinois | 128 of 132 | 97% |
| Indiana | 135 of 138 | 97.8% |
| Iowa | 61 of 64 | 95.3% |
| Kansas | 79 of 84 | 94% |
| Kentucky | 118 of 121 | 97.5% |
| Louisiana | 122 of 125 | 97.6% |
| Maine | 49 of 52 | 94.2% |
| Maryland | 35 of 49 | 71.4% |
| Massachusetts | 85 of 89 | 95.5% |
| Michigan | 178 of 182 | 97.8% |
| Minnesota | 60 of 63 | 95.2% |
| Mississippi | 100 of 104 | 96.2% |
| Missouri | 166 of 170 | 97.6% |
| Montana | 22 of 27 | 81.5% |
| Nebraska | 45 of 51 | 88.2% |
| Nevada | 93 of 100 | 93% |
| New Hampshire | 22 of 25 | 88% |
| New Jersey | 68 of 73 | 93.2% |
| New Mexico | 64 of 68 | 94.1% |
| New York | 200 of 215 | 93% |
| North Carolina | 172 of 176 | 97.7% |
| North Dakota | 23 of 26 | 88.5% |
| Northern Mariana Islands | 1 of 1 | 100% |
| Ohio | 167 of 171 | 97.7% |
| Oklahoma | 78 of 81 | 96.3% |
| Oregon | 85 of 92 | 92.4% |
| Pennsylvania | 259 of 323 | 80.2% |
| Puerto Rico | 63 of 64 | 98.4% |
| Rhode Island | 25 of 29 | 86.2% |
| South Carolina | 86 of 89 | 96.6% |
| South Dakota | 27 of 30 | 90% |
| Tennessee | 151 of 156 | 96.8% |
| Texas | 403 of 407 | 99% |
| U.S. Virgin Islands | 1 of 1 | 100% |
| Utah | 50 of 53 | 94.3% |
| Vermont | 10 of 14 | 71.4% |
| Virginia | 134 of 144 | 93.1% |
| Washington | 95 of 114 | 83.3% |
| West Virginia | 60 of 69 | 87% |
| Wisconsin | 93 of 96 | 96.9% |
| Wyoming | 10 of 13 | 76.9% |
Medicare Part D paid for 6,222,965 30-day fills of Esomeprazole in 2024 for about 741,564 enrollees, at an average total cost of $18.80 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Esomeprazole and the rest of a client's list on every plan in their county.
Estimate Esomeprazole 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.