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Nexlizet is a brand of bempedoic acid / ezetimibe. 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, 4,998 of 5,492 Medicare Part D and Medicare Advantage drug plans (91%) list Nexlizet on their formulary, across 259 of 286 formularies. The most common placement is tier 3 (4,359 plans, 87.2% of those covering it). 3,145 of the covering plans require prior authorization (62.9%), 168 step therapy and 4,719 a quantity limit.
500 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $42, 67 of them $0; 4,498 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: 4,923 of 5,496 plans covered it (89.6%); 2027: 4,998 of 5,492 (91%).
Of 4,367 plans offered in both years, 5 added it to the formulary and 19 dropped it.
Among plans covering it both years, 70 moved it to a higher tier and 10 to a lower one; 24 added prior authorization and 9 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 113 |
| Tier 2 | 45 |
| Tier 3 | 4,359 |
| Tier 4 | 481 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 213 of 323 | 65.9% | 88.7% |
| Medicare Advantage with drugs (MA-PD) | 2,961 of 3,200 | 92.5% | 63.8% |
| Special needs plans (SNP) | 1,824 of 1,969 | 92.6% | 58.6% |
| Carrier | Plans covering | Usual tier | Prior auth |
|---|---|---|---|
| Humana | 846 of 846 | Tier 3 | 846 |
| UnitedHealthcare | 830 of 830 | Tier 3 | 830 |
| 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 | 186 |
| Kaiser Permanente | 112 of 112 | Tier 4 | 16 |
| SCAN Health Plan | 83 of 83 | Tier 3 | 83 |
| Highmark Blue Cross Blue Shield or Highmark Blue Shield | 80 of 80 | Tier 4 | 80 |
| Alignment Health Plan | 77 of 77 | Tier 3 | 77 |
| Anthem Blue Cross and Blue Shield | 74 of 74 | Tier 3 | 74 |
| Wellpoint | 63 of 63 | Tier 3 | 63 |
| Priority Health Medicare | 40 of 40 | Tier 4 | 40 |
| CarePlus Health Plans, Inc. | 37 of 37 | Tier 3 | 37 |
| Zing Health | 36 of 36 | Tier 3 | 0 |
| Capital Blue Cross | 8 of 35 | Tier 3 | 8 |
| Prominence Health Plan | 29 of 29 | Tier 3 | 29 |
| Medica | 1 of 27 | Tier 3 | 1 |
| Anthem HealthKeepers | 26 of 26 | Tier 3 | 26 |
| Blue Cross Blue Shield of Michigan | 26 of 26 | Tier 4 | 26 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 111 of 114 | 97.4% |
| Alaska | 6 of 9 | 66.7% |
| American Samoa | 1 of 1 | 100% |
| Arizona | 139 of 147 | 94.6% |
| Arkansas | 78 of 85 | 91.8% |
| California | 354 of 397 | 89.2% |
| Colorado | 103 of 106 | 97.2% |
| Connecticut | 47 of 54 | 87% |
| Delaware | 35 of 43 | 81.4% |
| District of Columbia | 12 of 12 | 100% |
| Florida | 516 of 545 | 94.7% |
| Georgia | 131 of 149 | 87.9% |
| Guam | 1 of 1 | 100% |
| Hawaii | 47 of 50 | 94% |
| Idaho | 42 of 45 | 93.3% |
| Illinois | 121 of 132 | 91.7% |
| Indiana | 132 of 138 | 95.7% |
| Iowa | 57 of 64 | 89.1% |
| Kansas | 78 of 84 | 92.9% |
| Kentucky | 111 of 121 | 91.7% |
| Louisiana | 112 of 125 | 89.6% |
| Maine | 45 of 52 | 86.5% |
| Maryland | 46 of 49 | 93.9% |
| Massachusetts | 86 of 89 | 96.6% |
| Michigan | 173 of 182 | 95.1% |
| Minnesota | 42 of 63 | 66.7% |
| Mississippi | 88 of 104 | 84.6% |
| Missouri | 162 of 170 | 95.3% |
| Montana | 24 of 27 | 88.9% |
| Nebraska | 43 of 51 | 84.3% |
| Nevada | 95 of 100 | 95% |
| New Hampshire | 22 of 25 | 88% |
| New Jersey | 67 of 73 | 91.8% |
| New Mexico | 61 of 68 | 89.7% |
| New York | 201 of 215 | 93.5% |
| North Carolina | 167 of 176 | 94.9% |
| North Dakota | 17 of 26 | 65.4% |
| Northern Mariana Islands | 1 of 1 | 100% |
| Ohio | 148 of 171 | 86.5% |
| Oklahoma | 77 of 81 | 95.1% |
| Oregon | 82 of 92 | 89.1% |
| Pennsylvania | 286 of 323 | 88.5% |
| Puerto Rico | 21 of 64 | 32.8% |
| Rhode Island | 26 of 29 | 89.7% |
| South Carolina | 80 of 89 | 89.9% |
| South Dakota | 19 of 30 | 63.3% |
| Tennessee | 131 of 156 | 84% |
| Texas | 378 of 407 | 92.9% |
| U.S. Virgin Islands | 1 of 1 | 100% |
| Utah | 50 of 53 | 94.3% |
| Vermont | 11 of 14 | 78.6% |
| Virginia | 141 of 144 | 97.9% |
| Washington | 105 of 114 | 92.1% |
| West Virginia | 65 of 69 | 94.2% |
| Wisconsin | 83 of 96 | 86.5% |
| Wyoming | 10 of 13 | 76.9% |
Medicare Part D paid for 181,104 30-day fills of Nexlizet in 2024 for about 27,136 enrollees, at an average total cost of $390.26 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Nexlizet 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.