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Gemtesa is a brand of vibegron. 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, 4,373 of 5,492 Medicare Part D and Medicare Advantage drug plans (79.6%) list Gemtesa on their formulary, across 179 of 286 formularies. The most common placement is tier 4 (2,196 plans, 50.2% of those covering it). 1 of the covering plans require prior authorization (<0.1%), 15 step therapy and 3,235 a quantity limit.
197 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $42, 40 of them $0; 4,176 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: 4,411 of 5,496 plans covered it (80.3%); 2027: 4,373 of 5,492 (79.6%).
Of 4,367 plans offered in both years, 19 added it to the formulary and 163 dropped it.
Among plans covering it both years, 51 moved it to a higher tier and 231 to a lower one; 0 added prior authorization and 12 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 93 |
| Tier 3 | 2,084 |
| Tier 4 | 2,196 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 105 of 323 | 32.5% | 0% |
| Medicare Advantage with drugs (MA-PD) | 2,634 of 3,200 | 82.3% | 0% |
| Special needs plans (SNP) | 1,634 of 1,969 | 83% | <0.1% |
| Carrier | Plans covering | Usual tier | Prior auth |
|---|---|---|---|
| Humana | 744 of 846 | Tier 4 | 0 |
| UnitedHealthcare | 830 of 830 | Tier 4 | 0 |
| Devoted Health | 728 of 728 | Tier 3 | 0 |
| Aetna Medicare | 631 of 631 | Tier 3 | 0 |
| Wellcare | 0 of 268 | No tier listed | 0 |
| HealthSpring | 186 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 | 80 of 80 | Tier 4 | 0 |
| Alignment Health Plan | 0 of 77 | No tier listed | 0 |
| Anthem Blue Cross and Blue Shield | 74 of 74 | Tier 4 | 0 |
| Wellpoint | 58 of 63 | Tier 4 | 0 |
| Priority Health Medicare | 0 of 40 | No tier listed | 0 |
| CarePlus Health Plans, Inc. | 37 of 37 | Tier 4 | 0 |
| Zing Health | 36 of 36 | Tier 3 | 0 |
| Capital Blue Cross | 0 of 35 | No tier listed | 0 |
| Prominence Health Plan | 29 of 29 | Tier 4 | 0 |
| Medica | 27 of 27 | Tier 3 | 0 |
| Anthem HealthKeepers | 22 of 26 | Tier 4 | 0 |
| Blue Cross Blue Shield of Michigan | 26 of 26 | Tier 4 | 0 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 104 of 114 | 91.2% |
| Alaska | 3 of 9 | 33.3% |
| American Samoa | 1 of 1 | 100% |
| Arizona | 121 of 147 | 82.3% |
| Arkansas | 70 of 85 | 82.4% |
| California | 235 of 397 | 59.2% |
| Colorado | 83 of 106 | 78.3% |
| Connecticut | 44 of 54 | 81.5% |
| Delaware | 34 of 43 | 79.1% |
| District of Columbia | 9 of 12 | 75% |
| Florida | 410 of 545 | 75.2% |
| Georgia | 122 of 149 | 81.9% |
| Guam | 1 of 1 | 100% |
| Hawaii | 38 of 50 | 76% |
| Idaho | 36 of 45 | 80% |
| Illinois | 116 of 132 | 87.9% |
| Indiana | 126 of 138 | 91.3% |
| Iowa | 53 of 64 | 82.8% |
| Kansas | 70 of 84 | 83.3% |
| Kentucky | 106 of 121 | 87.6% |
| Louisiana | 109 of 125 | 87.2% |
| Maine | 42 of 52 | 80.8% |
| Maryland | 33 of 49 | 67.3% |
| Massachusetts | 83 of 89 | 93.3% |
| Michigan | 115 of 182 | 63.2% |
| Minnesota | 44 of 63 | 69.8% |
| Mississippi | 81 of 104 | 77.9% |
| Missouri | 156 of 170 | 91.8% |
| Montana | 20 of 27 | 74.1% |
| Nebraska | 38 of 51 | 74.5% |
| Nevada | 74 of 100 | 74% |
| New Hampshire | 19 of 25 | 76% |
| New Jersey | 62 of 73 | 84.9% |
| New Mexico | 55 of 68 | 80.9% |
| New York | 170 of 215 | 79.1% |
| North Carolina | 153 of 176 | 86.9% |
| North Dakota | 19 of 26 | 73.1% |
| Northern Mariana Islands | 1 of 1 | 100% |
| Ohio | 151 of 171 | 88.3% |
| Oklahoma | 68 of 81 | 84% |
| Oregon | 56 of 92 | 60.9% |
| Pennsylvania | 249 of 323 | 77.1% |
| Puerto Rico | 1 of 64 | 1.6% |
| Rhode Island | 18 of 29 | 62.1% |
| South Carolina | 77 of 89 | 86.5% |
| South Dakota | 23 of 30 | 76.7% |
| Tennessee | 143 of 156 | 91.7% |
| Texas | 349 of 407 | 85.7% |
| U.S. Virgin Islands | 1 of 1 | 100% |
| Utah | 42 of 53 | 79.2% |
| Vermont | 8 of 14 | 57.1% |
| Virginia | 126 of 144 | 87.5% |
| Washington | 83 of 114 | 72.8% |
| West Virginia | 62 of 69 | 89.9% |
| Wisconsin | 86 of 96 | 89.6% |
| Wyoming | 6 of 13 | 46.2% |
Medicare Part D paid for 2,111,999 30-day fills of Gemtesa in 2024 for about 320,144 enrollees, at an average total cost of $446.75 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Gemtesa and the rest of a client's list on every plan in their county.
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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.