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Xultophy is a brand of insulin degludec / liraglutide. 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, 1,560 of 5,492 Medicare Part D and Medicare Advantage drug plans (28.4%) list Xultophy on their formulary, across 105 of 286 formularies. The most common placement is tier 3 (1,497 plans, 96% of those covering it). 0 of the covering plans require prior authorization (0%), 13 step therapy and 1,539 a quantity limit.
137 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $42, 37 of them $0; 1,423 charge coinsurance instead — median 17% of the drug's cost. Covered insulin is capped at $35 for a month's supply.
2026: 1,870 of 5,496 plans covered it (34%); 2027: 1,560 of 5,492 (28.4%).
Of 4,367 plans offered in both years, 6 added it to the formulary and 283 dropped it.
Among plans covering it both years, 17 moved it to a higher tier and 9 to a lower one; 0 added prior authorization and 0 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 38 |
| Tier 2 | 5 |
| Tier 3 | 1,497 |
| Tier 5 | 2 |
| Tier 6 | 18 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 4 of 323 | 1.2% | 0% |
| Medicare Advantage with drugs (MA-PD) | 917 of 3,200 | 28.7% | 0% |
| Special needs plans (SNP) | 639 of 1,969 | 32.5% | 0% |
| 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 | 446 of 728 | Tier 3 | 0 |
| Aetna Medicare | 611 of 631 | Tier 3 | 0 |
| Wellcare | 0 of 268 | No tier listed | 0 |
| HealthSpring | 0 of 226 | No tier listed | 0 |
| Kaiser Permanente | 0 of 112 | No tier listed | 0 |
| SCAN Health Plan | 0 of 83 | No tier listed | 0 |
| Highmark Blue Cross Blue Shield or Highmark Blue Shield | 80 of 80 | Tier 3 | 0 |
| 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 | 36 of 36 | Tier 3 | 0 |
| Capital Blue Cross | 0 of 35 | No tier listed | 0 |
| Prominence Health Plan | 29 of 29 | Tier 3 | 0 |
| 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 | 44 of 114 | 38.6% |
| Alaska | 0 of 9 | 0% |
| American Samoa | 0 of 1 | 0% |
| Arizona | 44 of 147 | 29.9% |
| Arkansas | 27 of 85 | 31.8% |
| California | 81 of 397 | 20.4% |
| Colorado | 25 of 106 | 23.6% |
| Connecticut | 19 of 54 | 35.2% |
| Delaware | 12 of 43 | 27.9% |
| District of Columbia | 2 of 12 | 16.7% |
| Florida | 168 of 545 | 30.8% |
| Georgia | 29 of 149 | 19.5% |
| Guam | 0 of 1 | 0% |
| Hawaii | 17 of 50 | 34% |
| Idaho | 2 of 45 | 4.4% |
| Illinois | 40 of 132 | 30.3% |
| Indiana | 35 of 138 | 25.4% |
| Iowa | 18 of 64 | 28.1% |
| Kansas | 27 of 84 | 32.1% |
| Kentucky | 22 of 121 | 18.2% |
| Louisiana | 26 of 125 | 20.8% |
| Maine | 13 of 52 | 25% |
| Maryland | 15 of 49 | 30.6% |
| Massachusetts | 27 of 89 | 30.3% |
| Michigan | 36 of 182 | 19.8% |
| Minnesota | 10 of 63 | 15.9% |
| Mississippi | 24 of 104 | 23.1% |
| Missouri | 59 of 170 | 34.7% |
| Montana | 0 of 27 | 0% |
| Nebraska | 14 of 51 | 27.5% |
| Nevada | 29 of 100 | 29% |
| New Hampshire | 3 of 25 | 12% |
| New Jersey | 18 of 73 | 24.7% |
| New Mexico | 6 of 68 | 8.8% |
| New York | 116 of 215 | 54% |
| North Carolina | 42 of 176 | 23.9% |
| North Dakota | 3 of 26 | 11.5% |
| Northern Mariana Islands | 0 of 1 | 0% |
| Ohio | 52 of 171 | 30.4% |
| Oklahoma | 19 of 81 | 23.5% |
| Oregon | 25 of 92 | 27.2% |
| Pennsylvania | 144 of 323 | 44.6% |
| Puerto Rico | 0 of 64 | 0% |
| Rhode Island | 7 of 29 | 24.1% |
| South Carolina | 21 of 89 | 23.6% |
| South Dakota | 7 of 30 | 23.3% |
| Tennessee | 48 of 156 | 30.8% |
| Texas | 115 of 407 | 28.3% |
| U.S. Virgin Islands | 0 of 1 | 0% |
| Utah | 11 of 53 | 20.8% |
| Vermont | 2 of 14 | 14.3% |
| Virginia | 22 of 144 | 15.3% |
| Washington | 22 of 114 | 19.3% |
| West Virginia | 22 of 69 | 31.9% |
| Wisconsin | 18 of 96 | 18.8% |
| Wyoming | 0 of 13 | 0% |
Medicare Part D paid for 103,192 30-day fills of Xultophy in 2024 for about 13,670 enrollees, at an average total cost of $880.09 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Xultophy and the rest of a client's list on every plan in their county.
Estimate Xultophy 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.