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Insulin Lispro is the generic ingredient; brand versions: Humalog, Humalog Mix, Admelog, Lyumjev. 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, 3,863 of 5,492 Medicare Part D and Medicare Advantage drug plans (70.3%) list Insulin Lispro on their formulary, across 248 of 286 formularies. The most common placement is tier 3 (3,579 plans, 92.6% of those covering it). 0 of the covering plans require prior authorization (0%), 0 step therapy and 479 a quantity limit.
634 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $40, 223 of them $0; 3,229 charge coinsurance instead — median 21% of the drug's cost. Covered insulin is capped at $35 for a month's supply.
2026: 4,002 of 5,496 plans covered it (72.8%); 2027: 3,863 of 5,492 (70.3%).
Of 4,367 plans offered in both years, 10 added it to the formulary and 76 dropped it.
Among plans covering it both years, 51 moved it to a higher tier and 15 to a lower one; 0 added prior authorization and 0 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 120 |
| Tier 2 | 110 |
| Tier 3 | 3,579 |
| Tier 4 | 24 |
| Tier 5 | 2 |
| Tier 6 | 28 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 195 of 323 | 60.4% | 0% |
| Medicare Advantage with drugs (MA-PD) | 2,258 of 3,200 | 70.6% | 0% |
| Special needs plans (SNP) | 1,410 of 1,969 | 71.6% | 0% |
| Carrier | Plans covering | Usual tier | Prior auth |
|---|---|---|---|
| Humana | 846 of 846 | Tier 3 | 0 |
| UnitedHealthcare | 830 of 830 | Tier 3 | 0 |
| Devoted Health | 446 of 728 | Tier 3 | 0 |
| Aetna Medicare | 0 of 631 | No tier listed | 0 |
| Wellcare | 0 of 268 | No tier listed | 0 |
| HealthSpring | 186 of 226 | Tier 3 | 0 |
| Kaiser Permanente | 112 of 112 | Tier 3 | 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 3 | 0 |
| Anthem Blue Cross and Blue Shield | 0 of 74 | No tier listed | 0 |
| Wellpoint | 0 of 63 | No tier listed | 0 |
| Priority Health Medicare | 40 of 40 | Tier 3 | 0 |
| CarePlus Health Plans, Inc. | 37 of 37 | Tier 2 | 0 |
| Zing Health | 36 of 36 | Tier 3 | 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 3 | 0 |
| Anthem HealthKeepers | 0 of 26 | No tier listed | 0 |
| Blue Cross Blue Shield of Michigan | 26 of 26 | Tier 3 | 0 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 94 of 114 | 82.5% |
| Alaska | 5 of 9 | 55.6% |
| American Samoa | 1 of 1 | 100% |
| Arizona | 111 of 147 | 75.5% |
| Arkansas | 59 of 85 | 69.4% |
| California | 317 of 397 | 79.8% |
| Colorado | 82 of 106 | 77.4% |
| Connecticut | 24 of 54 | 44.4% |
| Delaware | 26 of 43 | 60.5% |
| District of Columbia | 9 of 12 | 75% |
| Florida | 374 of 545 | 68.6% |
| Georgia | 99 of 149 | 66.4% |
| Guam | 1 of 1 | 100% |
| Hawaii | 40 of 50 | 80% |
| Idaho | 33 of 45 | 73.3% |
| Illinois | 88 of 132 | 66.7% |
| Indiana | 82 of 138 | 59.4% |
| Iowa | 43 of 64 | 67.2% |
| Kansas | 47 of 84 | 56% |
| Kentucky | 78 of 121 | 64.5% |
| Louisiana | 89 of 125 | 71.2% |
| Maine | 35 of 52 | 67.3% |
| Maryland | 43 of 49 | 87.8% |
| Massachusetts | 78 of 89 | 87.6% |
| Michigan | 142 of 182 | 78% |
| Minnesota | 53 of 63 | 84.1% |
| Mississippi | 71 of 104 | 68.3% |
| Missouri | 100 of 170 | 58.8% |
| Montana | 22 of 27 | 81.5% |
| Nebraska | 35 of 51 | 68.6% |
| Nevada | 63 of 100 | 63% |
| New Hampshire | 19 of 25 | 76% |
| New Jersey | 45 of 73 | 61.6% |
| New Mexico | 57 of 68 | 83.8% |
| New York | 134 of 215 | 62.3% |
| North Carolina | 130 of 176 | 73.9% |
| North Dakota | 20 of 26 | 76.9% |
| Northern Mariana Islands | 1 of 1 | 100% |
| Ohio | 121 of 171 | 70.8% |
| Oklahoma | 58 of 81 | 71.6% |
| Oregon | 64 of 92 | 69.6% |
| Pennsylvania | 239 of 323 | 74% |
| Puerto Rico | 62 of 64 | 96.9% |
| Rhode Island | 23 of 29 | 79.3% |
| South Carolina | 63 of 89 | 70.8% |
| South Dakota | 20 of 30 | 66.7% |
| Tennessee | 103 of 156 | 66% |
| Texas | 262 of 407 | 64.4% |
| U.S. Virgin Islands | 1 of 1 | 100% |
| Utah | 41 of 53 | 77.4% |
| Vermont | 11 of 14 | 78.6% |
| Virginia | 102 of 144 | 70.8% |
| Washington | 89 of 114 | 78.1% |
| West Virginia | 49 of 69 | 71% |
| Wisconsin | 78 of 96 | 81.3% |
| Wyoming | 10 of 13 | 76.9% |
Medicare Part D paid for 1,708,842 30-day fills of Insulin Lispro in 2024 for about 389,598 enrollees, at an average total cost of $95.71 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Insulin Lispro 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.