Home › Agent Hub › Agent Tools › Part D coverage by drug › Orencia
Agent Tools
Orencia is a brand of abatacept. 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, 633 of 5,492 Medicare Part D and Medicare Advantage drug plans (11.5%) list Orencia on their formulary, across 84 of 286 formularies. The most common placement is tier 5 (549 plans, 86.7% of those covering it). 536 of the covering plans require prior authorization (84.7%), 0 step therapy and 447 a quantity limit.
19 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $0, 19 of them $0; 614 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: 1,251 of 5,496 plans covered it (22.8%); 2027: 633 of 5,492 (11.5%).
Of 4,367 plans offered in both years, 25 added it to the formulary and 448 dropped it.
Among plans covering it both years, 12 moved it to a higher tier and 1 to a lower one; 0 added prior authorization and 0 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 79 |
| Tier 2 | 1 |
| Tier 4 | 4 |
| Tier 5 | 549 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 2 of 323 | 0.6% | 100% |
| Medicare Advantage with drugs (MA-PD) | 395 of 3,200 | 12.3% | 83% |
| Special needs plans (SNP) | 236 of 1,969 | 12% | 87.3% |
| Carrier | Plans covering | Usual tier | Prior auth |
|---|---|---|---|
| Humana | 0 of 846 | No tier listed | 0 |
| UnitedHealthcare | 0 of 830 | No tier listed | 0 |
| Devoted Health | 0 of 728 | No tier listed | 0 |
| Aetna Medicare | 0 of 631 | No tier listed | 0 |
| Wellcare | 0 of 268 | No tier listed | 0 |
| HealthSpring | 0 of 226 | No tier listed | 0 |
| Kaiser Permanente | 112 of 112 | Tier 5 | 16 |
| SCAN Health Plan | 0 of 83 | No tier listed | 0 |
| Highmark Blue Cross Blue Shield or Highmark Blue Shield | 80 of 80 | Tier 5 | 80 |
| Alignment Health Plan | 0 of 77 | No tier listed | 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 | 0 of 40 | No tier listed | 0 |
| CarePlus Health Plans, Inc. | 0 of 37 | No tier listed | 0 |
| Zing Health | 0 of 36 | No tier listed | 0 |
| Capital Blue Cross | 0 of 35 | No tier listed | 0 |
| Prominence Health Plan | 29 of 29 | Tier 5 | 29 |
| Medica | 0 of 27 | No tier listed | 0 |
| Anthem HealthKeepers | 0 of 26 | No tier listed | 0 |
| Blue Cross Blue Shield of Michigan | 0 of 26 | No tier listed | 0 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 3 of 114 | 2.6% |
| Alaska | 0 of 9 | 0% |
| American Samoa | 0 of 1 | 0% |
| Arizona | 9 of 147 | 6.1% |
| Arkansas | 3 of 85 | 3.5% |
| California | 69 of 397 | 17.4% |
| Colorado | 15 of 106 | 14.2% |
| Connecticut | 0 of 54 | 0% |
| Delaware | 5 of 43 | 11.6% |
| District of Columbia | 3 of 12 | 25% |
| Florida | 45 of 545 | 8.3% |
| Georgia | 16 of 149 | 10.7% |
| Guam | 0 of 1 | 0% |
| Hawaii | 7 of 50 | 14% |
| Idaho | 1 of 45 | 2.2% |
| Illinois | 2 of 132 | 1.5% |
| Indiana | 5 of 138 | 3.6% |
| Iowa | 8 of 64 | 12.5% |
| Kansas | 2 of 84 | 2.4% |
| Kentucky | 1 of 121 | 0.8% |
| Louisiana | 4 of 125 | 3.2% |
| Maine | 0 of 52 | 0% |
| Maryland | 12 of 49 | 24.5% |
| Massachusetts | 41 of 89 | 46.1% |
| Michigan | 5 of 182 | 2.7% |
| Minnesota | 4 of 63 | 6.3% |
| Mississippi | 5 of 104 | 4.8% |
| Missouri | 7 of 170 | 4.1% |
| Montana | 0 of 27 | 0% |
| Nebraska | 5 of 51 | 9.8% |
| Nevada | 13 of 100 | 13% |
| New Hampshire | 0 of 25 | 0% |
| New Jersey | 11 of 73 | 15.1% |
| New Mexico | 3 of 68 | 4.4% |
| New York | 33 of 215 | 15.3% |
| North Carolina | 26 of 176 | 14.8% |
| North Dakota | 4 of 26 | 15.4% |
| Northern Mariana Islands | 0 of 1 | 0% |
| Ohio | 13 of 171 | 7.6% |
| Oklahoma | 6 of 81 | 7.4% |
| Oregon | 9 of 92 | 9.8% |
| Pennsylvania | 123 of 323 | 38.1% |
| Puerto Rico | 37 of 64 | 57.8% |
| Rhode Island | 0 of 29 | 0% |
| South Carolina | 12 of 89 | 13.5% |
| South Dakota | 4 of 30 | 13.3% |
| Tennessee | 3 of 156 | 1.9% |
| Texas | 32 of 407 | 7.9% |
| U.S. Virgin Islands | 0 of 1 | 0% |
| Utah | 1 of 53 | 1.9% |
| Vermont | 0 of 14 | 0% |
| Virginia | 8 of 144 | 5.6% |
| Washington | 20 of 114 | 17.5% |
| West Virginia | 17 of 69 | 24.6% |
| Wisconsin | 5 of 96 | 5.2% |
| Wyoming | 0 of 13 | 0% |
Medicare Part D paid for 100,788 30-day fills of Orencia in 2024 for about 13,542 enrollees, at an average total cost of $5,641.28 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Orencia and the rest of a client's list on every plan in their county.
Estimate Orencia 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.