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Ezetimibe / Simvastatin 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, 5,219 of 5,492 Medicare Part D and Medicare Advantage drug plans (95%) list Ezetimibe / Simvastatin on their formulary, across 270 of 286 formularies. The most common placement is tier 1 (4,045 plans, 77.5% of those covering it). 0 of the covering plans require prior authorization (0%), 17 step therapy and 4,984 a quantity limit.
4,785 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $0, 4,442 of them $0; 434 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: 5,191 of 5,496 plans covered it (94.5%); 2027: 5,219 of 5,492 (95%).
Of 4,367 plans offered in both years, 70 added it to the formulary and 35 dropped it.
Among plans covering it both years, 58 moved it to a higher tier and 413 to a lower one; 0 added prior authorization and 0 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 4,045 |
| Tier 2 | 253 |
| Tier 3 | 247 |
| Tier 4 | 44 |
| Tier 5 | 3 |
| Tier 6 | 627 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 287 of 323 | 88.9% | 0% |
| Medicare Advantage with drugs (MA-PD) | 3,026 of 3,200 | 94.6% | 0% |
| Special needs plans (SNP) | 1,906 of 1,969 | 96.8% | 0% |
| Carrier | Plans covering | Usual tier | Prior auth |
|---|---|---|---|
| Humana | 846 of 846 | Tier 1 | 0 |
| UnitedHealthcare | 830 of 830 | Tier 1 | 0 |
| Devoted Health | 728 of 728 | Tier 1 | 0 |
| Aetna Medicare | 631 of 631 | Tier 1 | 0 |
| Wellcare | 234 of 268 | Tier 6 | 0 |
| HealthSpring | 226 of 226 | Tier 1 | 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 | 80 of 80 | Tier 3 | 0 |
| Alignment Health Plan | 77 of 77 | Tier 6 | 0 |
| Anthem Blue Cross and Blue Shield | 74 of 74 | Tier 1 | 0 |
| Wellpoint | 63 of 63 | Tier 1 | 0 |
| Priority Health Medicare | 0 of 40 | No tier listed | 0 |
| CarePlus Health Plans, Inc. | 37 of 37 | Tier 1 | 0 |
| Zing Health | 36 of 36 | Tier 1 | 0 |
| Capital Blue Cross | 35 of 35 | Tier 3 | 0 |
| Prominence Health Plan | 0 of 29 | No tier listed | 0 |
| Medica | 27 of 27 | Tier 1 | 0 |
| Anthem HealthKeepers | 26 of 26 | Tier 1 | 0 |
| Blue Cross Blue Shield of Michigan | 26 of 26 | Tier 4 | 0 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 113 of 114 | 99.1% |
| Alaska | 8 of 9 | 88.9% |
| American Samoa | 1 of 1 | 100% |
| Arizona | 146 of 147 | 99.3% |
| Arkansas | 83 of 85 | 97.6% |
| California | 347 of 397 | 87.4% |
| Colorado | 94 of 106 | 88.7% |
| Connecticut | 52 of 54 | 96.3% |
| Delaware | 40 of 43 | 93% |
| District of Columbia | 9 of 12 | 75% |
| Florida | 538 of 545 | 98.7% |
| Georgia | 140 of 149 | 94% |
| Guam | 1 of 1 | 100% |
| Hawaii | 43 of 50 | 86% |
| Idaho | 36 of 45 | 80% |
| Illinois | 131 of 132 | 99.2% |
| Indiana | 137 of 138 | 99.3% |
| Iowa | 63 of 64 | 98.4% |
| Kansas | 83 of 84 | 98.8% |
| Kentucky | 120 of 121 | 99.2% |
| Louisiana | 124 of 125 | 99.2% |
| Maine | 51 of 52 | 98.1% |
| Maryland | 38 of 49 | 77.6% |
| Massachusetts | 87 of 89 | 97.8% |
| Michigan | 141 of 182 | 77.5% |
| Minnesota | 62 of 63 | 98.4% |
| Mississippi | 103 of 104 | 99% |
| Missouri | 169 of 170 | 99.4% |
| Montana | 24 of 27 | 88.9% |
| Nebraska | 50 of 51 | 98% |
| Nevada | 86 of 100 | 86% |
| New Hampshire | 24 of 25 | 96% |
| New Jersey | 72 of 73 | 98.6% |
| New Mexico | 64 of 68 | 94.1% |
| New York | 214 of 215 | 99.5% |
| North Carolina | 175 of 176 | 99.4% |
| North Dakota | 25 of 26 | 96.2% |
| Northern Mariana Islands | 1 of 1 | 100% |
| Ohio | 166 of 171 | 97.1% |
| Oklahoma | 80 of 81 | 98.8% |
| Oregon | 87 of 92 | 94.6% |
| Pennsylvania | 288 of 323 | 89.2% |
| Puerto Rico | 64 of 64 | 100% |
| Rhode Island | 27 of 29 | 93.1% |
| South Carolina | 88 of 89 | 98.9% |
| South Dakota | 29 of 30 | 96.7% |
| Tennessee | 155 of 156 | 99.4% |
| Texas | 393 of 407 | 96.6% |
| U.S. Virgin Islands | 1 of 1 | 100% |
| Utah | 52 of 53 | 98.1% |
| Vermont | 12 of 14 | 85.7% |
| Virginia | 137 of 144 | 95.1% |
| Washington | 97 of 114 | 85.1% |
| West Virginia | 67 of 69 | 97.1% |
| Wisconsin | 90 of 96 | 93.8% |
| Wyoming | 12 of 13 | 92.3% |
Medicare Part D paid for 696,147 30-day fills of Ezetimibe / Simvastatin in 2024 for about 69,672 enrollees, at an average total cost of $34.17 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Ezetimibe / Simvastatin and the rest of a client's list on every plan in their county.
Estimate Ezetimibe / Simvastatin 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.