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Methadone Part D coverage 2027

Methadone 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.

Coverage at a glance

In 2027, 5,445 of 5,492 Medicare Part D and Medicare Advantage drug plans (99.1%) list Methadone on their formulary, across 283 of 286 formularies. The most common placement is tier 3 (3,937 plans, 72.3% of those covering it). 2,104 of the covering plans require prior authorization (38.6%), 0 step therapy and 5,088 a quantity limit.

What a 30-day fill costs

1,259 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $0, 707 of them $0; 4,186 charge coinsurance instead — median 20% 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.

What changed since 2026

2026: 5,442 of 5,496 plans covered it (99%); 2027: 5,445 of 5,492 (99.1%).

Of 4,367 plans offered in both years, 0 added it to the formulary and 0 dropped it.

Among plans covering it both years, 50 moved it to a higher tier and 270 to a lower one; 12 added prior authorization and 27 removed it.

Tier placement

By plan type

By carrier

By state

Medicare usage

Medicare Part D paid for 559,287 30-day fills of Methadone in 2024 for about 66,107 enrollees, at an average total cost of $18.79 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).

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.